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J Acquir Immune Defic Syndr. 2020 Jan 6. doi: 10.1097/QAI.0000000000002264. [Epub ahead of print]

HIV seroconversion and types of relationships among men who have sex with men: A cohort study in China.

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Department of Child, Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing 100069, China.
Department of Pathology, Daxing District People's Hospital, Beijing100026, China.
Chaoyang Center for Disease Control and Prevention, Beijing 100021, China.
State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing 102206, China.
Yale School of Public Health, Yale University, New Haven, CT 06510-3201, USA.



The role of partner types in modifying HIV seroconversion risk among men who have sex with men (MSM) is complex. We sought to understand the role of regular sexual partners and risky sexual behavior in contributing to incident HIV infection among MSM.


From July 2011 to August 2017, we recruited HIV-negative men who reported having anal or oral homosexual encounters in the past 6 months, following them every 3 months for two visits. We collected sociodemographic and behavioral characteristics by self-administrated questionnaire. HIV status was confirmed by sequential rapid test and confirmatory test. We used multivariable Cox regression to identify risk factors and interaction models to evaluate the relative excess risk between relevant variables.


Among 1218 participants, HIV seroconversion rate was 3.66/100 person-years. HIV seroconversion was associated with lower educational attainment (adjusted hazards ratio [aHR]=1.73, 95%CI: 1.06-2.81), having had penetrative sex with male before age of 18 (aHR=2.44, 95%CI: 1.20-4.99), not using condoms in the last sexual encounter (aHR=2.19, 95%CI: 1.29-3.71), having regular but not committed partners (aHR=3.33, 95%CI: 1.77-6.93). Among 890 (73%) of men reported having regular partners, HIV seroconversion was more frequent in men whose stable partners were not committed as boyfriends (aHR=3.31, 95%CI: 1.73-6.36) and in men having unprotected anal sex (aHR=2.61, 95%CI: 1.42-4.80). Interaction between these two factors was observed (relative excess risk of interaction=4.53).


Incidence among MSM in China was high; unprotected sex with steady, but not committed partners was associated with increased seroconversion risk. It is imperative to expand safer sex education and training for MSM to reduce unsafe sexual behaviors, including awareness that casual partners are not the only source of infection.

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