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PLoS One. 2016 Apr 26;11(4):e0154132. doi: 10.1371/journal.pone.0154132. eCollection 2016.

Condomless Vaginal Intercourse and Its Associates among Men Who Have Sex with Men in China.

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Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, China.
University of North Carolina, Project-China, Guangzhou, China.
Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
Monitoring and Evaluation Unit, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland.



HIV prevalence has increased rapidly among men who have sex with men (MSM) in China reaching alarmingly high levels in some cities. Bisexual MSM have potential to transmit HIV and syphilis to their female partners through condomless vaginal intercourse (CVI). Thus, estimation of the burden of CVI and identification of its associates seemed necessary to control this cross-gender transmission.


In a cross-sectional study, using respondent-driven-sampling and snowball sampling, 2958 MSM were recruited from seven Chinese cities, interviewed and tested for HIV and syphilis. Descriptive analysis of the socio-demographic and behaviors followed by simple and multiple logistic regressions [adjusted for income, city, race and social network size to determine adjusted odds ratio (aOR)] were performed using SAS-9.1.


Among participating MSM, 19.03% were engaged in CVI. Prevalence of HIV and syphilis among participants involved in CVI were 5.86% and 14.74% respectively. MSM who were older [aOR for aged 40-49 = 2.60 (95% CI: 1.54-4.37)], married [aOR = 6.13 (4.95-7.58)], attended primary school or below [aOR = 3.86 (2.26-6.69)], met male partners at spa/bathhouse/sauna/massage parlor [aOR = 3.52 (2.62-4.72)] and had heterosexual orientation [aOR = 13.81 (7.14-26.70)] were more likely to have CVI. Furthermore, correct knowledge regarding HIV [aOR = 0.70 (0.55, 0.88)] and exposure to HIV prevention interventions [aOR = 0.67 (0.54, 0.82)] were negatively associated with CVI.


CVI was found to be common among MSM in China. To minimize the transmission of HIV and syphilis from bisexual MSM to their relatively female partners, targeted interventions should specifically focus on bisexual MSM especially the older and married subgroups.

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