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J Med Internet Res. 2019 Jan 21;21(1):e10171. doi: 10.2196/10171.

Leading by Example: Web-Based Sexual Health Influencers Among Men Who Have Sex With Men Have Higher HIV and Syphilis Testing Rates in China.

Wu D1,2,3,4, Tang W1,2,3, Lu H1,5, Zhang TP1,6, Cao B7, Ong JJ4,8, Lee A1,2, Liu C9, Huang W1,2, Fu R2, Li K10, Pan SW11, Zhang Y1,2,12, Fu H13, Wei C14, Tucker JD1,2,4.

Author information

University North Carolina at Chapel Hill, Project-China, Guangzhou, China.
Social Entrepreneurship to Spur Health Global, Guangzhou, China.
Dermatology Hospital of Southern Medical University, Guangzhou, China.
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States.
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States.
School of Media and Communication, Shenzhen University, Shenzhen, China.
Central Clinical School, Monash University, Monash, Australia.
Department of Sociology, University of California, San Diego, CA, United States.
Weill Cornell Medical College, New York, NY, United States.
Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China.
Kirby Institute, University of New South Wales, Sydney, Australia.
Eastern Virginia Medical School, Norfolk, VA, United States.
Department of Social and Behavior Health Sciences, Rutgers School of Public Health, Piscataway, NJ, United States.



The spread of healthy behaviors through social networks may be accelerated by influential individuals. Previous studies have used lay health influencers to prevent sexually transmitted infections (STIs) among internet-using men who have sex with men (MSM). However, there is a lack of understanding of the characteristics of this key subset of MSM.


This study aimed to examine sociodemographic characteristics, HIV and syphilis testing, and sexual behaviors of Web-based MSM sexual health influencers (SHIs) in China, defined as individuals with relatively stronger influence on spreading HIV and STI information online.


A Web-based survey of MSM was conducted in August 2017 as a final follow-up of a randomized controlled trial promoting HIV testing in 8 Chinese cities. Men were recruited through a gay social networking mobile phone app and were included if they were born biologically male, aged 16 years and above, ever had sex with another man, and HIV negative or with unknown HIV status. Information regarding sociodemographic characteristics, sexual behaviors, and HIV and syphilis testing was obtained. We assessed men's Web-based sexual health influence using a standardized 6-item opinion leadership scale focused on HIV and STI information. Influencers were defined as those whose mean score ranked within the top 13% (a higher score means greater influence). We used multivariable linear and logistic regression models to measure Web-based sexual health influence's association with HIV and syphilis testing, controlling for intervention trial effects, age, education, income, and marital status.


Overall, 1031 men completed the survey. Most men were younger than 30 years (819/1031, 79.43%) and had at least college education (667/1031, 64.69%). Influencers were more likely to get tested for HIV (73/132, 55.3% vs 337/899, 37.5%; P<.001) and syphilis (35/132, 26.5% vs 137/899, 15.2%; P=.001) in the last 3 months compared with noninfluencers. There were no significant differences in condomless sex with male partners (26/132, 19.7% vs 203/899, 22.6%; P=.46), mean number of male sex partners (1.32 vs 1.11; P=.16) in the last 3 months, and mainly meeting male sex partners online in the last 12 months (97/132, 73.5% vs 669/899, 74.4%; P=.82) between influencers and noninfluencers. Regression analyses showed that influencers had higher odds of HIV testing (adjusted odds ratio, AOR 2.16, 95% CI 1.48-3.17) and syphilis testing (AOR 1.99, 95% CI 1.28-3.10) in the last 3 months.


We identified Web-based SHIs who might be more likely to help promote healthy HIV and syphilis testing behaviors through MSM populations. Leveraging existing influencers may help improve HIV and syphilis testing among their networks.


China; HIV; health promotion; internet; men who have sex with men; peer influence; social media; social networks; syphilis

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