Participant Characteristics
Table 1 demonstrates the characteristics of the 699 MSM in Ningbo. The mean age was 31.9 (SD 8.8 )years. Most participants (81.1%) were less than 30 years, 63.4% were single, 70.4% had a high school education or above, 77.7% had lived in Ningbo for at least two years, 62.9% had an income above 5000 China Yuan (CNY) per month, and 74.8% self-identified as gay.
Table 1
Characteristics of study participants and of HIVST users and Non-HIVST users in Ningbo, China, 2019
Characteristics | All participants n (%) | Subgroup comparison |
HIVST users n (%) | Non-HIVST users n (%) | P-valuec |
Overall | 699(100) | 267(100) | 432 (100) | |
Demographics | | | | |
Age (years) | | | | |
18~ | 330(47.2) | 155(58.1) | 175(40.5) | < 0.001 |
30~ | 237(33.9) | 92(34.5) | 145(33.6) | |
≥ 40 | 132(18.9) | 20(7.5) | 112(25.9) | |
Marital status | | | | |
Single | 443(63.4) | 172 (64.4) | 271 (62.7) | 0.653 |
Married | 256(36.6) | 95(35.6) | 161 (37.3) | |
Education level | | | | |
Middle school or less | 207(29.6) | 65(24.3) | 142(32.9) | 0.022 |
High school | 264(37.8) | 101(37.8) | 163(37.7) | |
College or above | 228(32.6) | 101(37.8) | 127(29.4) | |
duration of local residence(years) | | | | |
< 2 | 156(22.3) | 76(28.5) | 80(18.5) | 0.002 |
≥ 2 | 543(77.7) | 191 (71.5) | 352(81.5) | |
Monthly income (CNY) | | | | |
<5000 | 259(37.1) | 74(27.7) | 185(42.8) | < 0.001 |
≥5000 | 440(62.9) | 193(72.3) | 247 (57.2) | |
Sexual orientation | | | | |
Gay | 523(74.8) | 220 (82.4) | 303(70.1) | 0.001 |
Bisexual | 135(19.3) | 34 (12.7) | 101 (23.4) | |
Unknown/unsure | 41(5.9) | 13(4.9) | 28(6.5) | |
Gay apps usage | | | | |
Gay apps use | | |
Yes | 583(83.4) | 237(88.8) | 346(80.1) | 0.003 |
No | 116(16.6) | 30 (11.2) | 86(19.9) | |
Duration of gay apps use(years) | | | | |
< 1 | 83(14.2) | 25(10.5) | 58(16.8) | 0.035 |
≥ 1 | 500(85.8) | 212(89.5) | 288(83.2) | |
Missing(No use of gay apps) | 116 | | | |
Frequency of gay apps use(times/day) a | | | | |
< 1 | 66(11.3) | 22(9.3) | 44(12.7) | 0.036 |
1- | 185(31.7) | 65(27.4) | 120(34.7) | |
≥5 | 332(56.9) | 150(63.3) | 182(52.6) | |
Missing(No use of gay apps) | 116 | | | |
Sexual Behavior | | | | |
Role in sexual intercourse | | | | |
Insertive anal sex | 191(27.3) | 74(27.7) | 117(27.1) | 0.983 |
Receptive anal sex | 155(22.2) | 59(22.1) | 96(22.2) | |
Both | 353(50.5) | 134(50.2) | 219(50.5) | |
Frequency of male–male sexual contact (times/week) a | | | | |
<1 | 377 (53.9) | 124 (46.4) | 253 (58.6) | 0.002 |
≥ 1 | 322 (46.1) | 143 (53.6) | 179 (41.4) | |
Multiple male sex partners a | | | | |
Yes | 196(28.0) | 87(32.6) | 109 (25.2) | 0.035 |
No | 503(72.0) | 180 (67.4) | 323 (74.8) | |
Unprotected sex with men a | | | |
Yes | 190 (27.2) | 64(24.0) | 126 (29.2) | 0.133 |
No | 509 (72.8) | 203 (76.0) | 306(70.8) | |
Syphilis Infection b | | | | |
Yes | 44(6.3) | 29(10.9) | 15(3.5) | < 0.001 |
No | 655(93.7) | 238(89.1) | 417(96.5) | |
HIV testing | | | | |
Reason for HIV testing | | | | |
Regular HIV testing | 432(71.5) | 196(73.4) | 236(70.0) | 0.011 |
Had unprotected sexual behavior | 60(9.9) | 22(8.2) | 38(11.3) | |
Had suspicions symptoms of AIDS | 47(7.8) | 19(7.1) | 28(8.3) | |
Awareness of HIV testing results before sex | 36(6.0) | 10(3.7) | 26(7.7) | |
Repeated HIV testing | 29(4.8) | 20(7.5) | 9(2.7) | |
Missing(Had never HIV testing before) | 95 | | | |
Frequency of HIV testing b | | | | |
0 | 114(16.3) | 4(1.5) | 110(25.5) | < 0.001 |
1 | 220(31.5) | 76(28.5) | 144(33.3) | |
≥2 | 365(52.2) | 187(70.0) | 178(41.2) | |
Time since latest HIV testing (months) | | | | |
1~ | 148(24.5) | 81(30.3) | 67(19.9) | 0.005 |
4~ | 176(29.1) | 77(28.8) | 99(29.4) | |
7~ | 92(15.2) | 29(10.9) | 63(18.7) | |
13~ | 188(31.1) | 80(30.0) | 108(32.0) | |
Missing(Had never HIV testing before) | 95 | | | |
Site of the latest HIV testing | | | | |
CDC | 211(34.9) | 85(31.8) | 126(37.4) | 0.029 |
Hospital | 43(7.1) | 13(4.9) | 30(8.9) | |
NGO | 304(50.3) | 169(63.3) | 181(53.4) | |
Missing(Had never HIV testing before) | 95 | | | |
aIn the prior 6 months. b In the prior one year cSubgroups were compared using chi-square tests to generate P-values. |
Most participants (83.4%) had used gay apps in the past 6 months. Of the 583 gay app users, 85.8%( 500/583) had used gay apps for at least one year, 56.9%( 332/583) used them at least 5 times a day. In terms of sexual practice, half of the participants were engaged in both insertive anal intercourse and receptive anal intercourse equally. 46.1% had sex with men for at least once per week in the prior 6 months.72.0% had multiple male sex partners and 27.2% had unprotected sex with men in the prior 6 months.
Comparisons Of Characteristics Between Hivst Users And Non-hivst Users
Among all participants, 604(86.4%) reported having HIV testing at least once in their lifetimes, and 575(82.3%) had been tested in the past year. Table 1 describes that a total of 267 participants (of 699, 38.2%) reported having used an HIV self-test kit before, whereas 432 (61.8%) reported never having HIV self-test. Compared to non-HIVST users, a larger proportion of HIVST Users were aged between 18 ~ 29 years (58.1% versus 40.5%, p < 0.001), had college or above education level (37.8% versus 29.4%, p = 0.022), had lived in Ningbo less than two years (28.5% versus 18.5%, p = 0.002), had an income above 5000 China Yuan (CNY) per month (72.3% versus 57.2%, p < 0.001) and self-identified as gay (82.4% versus 70.1%, p < 0.001).
A larger proportion of HIVST Users reported having higher frequency of male-male sexual contact (≥ 1 time/week: 53.6% versus 41.4%, p = 0.002), having multiple male sex partners (32.6% versus 25.2%, p = 0.035), having had syphilis infection (10.9% versus 3.5%, p < 0.001) and having used gay apps(88.8% versus 80.1%, p = 0.003) in the prior 6 months. Among those who had used gay apps, a greater proportion of HIVST Users also had a higher frequency of gay apps use(≥ 5 times/day: 63.3% versus 52.6%, p = 0.036) in the prior 6 months and used gay apps over one year(89.5% versus 83.2%, p = 0.035).
A greater proportion of HIVST Users had a higher frequency of HIV testing(≥ 2 times: 70.0% versus 41.2%, p < 0.001) in the past one year. Among those who had HIV testing before, a greater proportion of HIVST Users reported having HIV testing regularly (73.4% versus 70.0%, p = 0.011), their most recent HIV testing had been within the prior 3 months(30.3% versus 19.9%, p = 0.005),the site of latest HIV testing was NGOs(63.3% versus 53.4%, p = 0.029).
Factor Associated With Hivst Uptake
As show in Table 2, multivariate logistic regression analyses found that HIVST were associated with older age (30–39 years: AOR = 0.49,CI = 0.32–0.76; more than 40 years: AOR = 0.07 ,CI = 0.04–0.14, compared to 18–29 years), higher education level (high school: AOR = 2.82, CI = 1.70–4.69, compared to middle school or less), bisexual(AOR = 0.49,CI = 0.29–0.84), gay apps use(AOR = 1.86,CI = 1.13–3.05), multiple male sex partners (AOR = 1.90,CI = 1.29–2.80), frequency of male–male sexual contact ≥ 1 times per week(AOR = 1.86, CI = 1.30–2.66), syphilis infection(AOR = 5.48, CI = 2.53–11.88).
Table 2
Factors associated with HIVST among study participants in Ningbo, China, 2019(n = 699)
Factor | Unadjusted OR (CI)b | P-value | Adjusted OR (CI)c | P-value |
Age (years) | | | | |
18~ | 1.00 | | 1.00 | N/A |
30~ | 0.72(0.51–1.01) | 0.054 | 0.49(0.32–0.76) | 0.001 |
≥ 40 | 0.20(0.12–0.34) | < 0.001 | 0.07(0.04–0.14) | < 0.001 |
Marital status | | | | |
Married | 1.00 | | N/A | N/A |
Single | 1.08(0.78–1.48) | 0.653 | N/A | 0.006 |
Education level | | | | |
Middle school or less | 1.00 | | 1.00 | N/A |
High school | 1.74(1.17–2.57) | 0.006 | 2.82(1.70–4.69) | < 0.001 |
College or above | 1.35(0.92–1.99) | 0.123 | 1.42(0.92–2.20) | 0.052 |
Local residence time | | | | |
< 2 | 1.00 | | 1.00 | N/A |
≥ 2 | 0.57(0.40–0.82) | 0.002 | 0.66(0.44-1.00) | 0.052 |
Monthly income RMB(GBP) | | | | |
<5000(115) | 1.00 | | 1.00 | N/A |
≥5000(578) | 1.95(1.41–2.71) | < 0.001 | 1.35(0.94–1.93) | 0.100 |
Sexual orientation | | | | |
Gay | 1.00 | | 1.00 | N/A |
Bisexual | 0.46(0.30–0.71) | < 0.001 | 0.49(0.29–0.84) | 0.009 |
Unknown/unsure | 0.64(0.32–1.26) | 0.198 | 0.71(0.34–1.51) | 0.379 |
Gay apps use | | | | |
No | 1.00 | | 1.00 | N/A |
Yes | 1.96(1.26–3.07) | 0.003 | 1.86(1.13–3.05) | 0.014 |
Multiple male sex partners a | | | | |
No | 1.00 | | 1.00 | N/A |
Yes | 1.43(1.02-2.00) | 0.036 | 1.90(1.29–2.80) | 0.001 |
Frequency of male–male sexual contact (times/week) a | | | | |
<1 | 1.00 | | 1.00 | N/A |
≥1 | 1.63(1.20–2.22) | 0.002 | 1.86(1.30–2.66) | 0.001 |
Unprotected sex with men a | | | | |
No | 1.00 | | N/A | N/A |
Yes | 0.77(0.54–1.09) | 0.134 | N/A | N/A |
Syphilis Infection | | | | |
No | 1.00 | | 1.00 | N/A |
Yes | 3.39(1.78–6.45) | < 0.001 | 5.48(2.53–11.88) | < 0.001 |
Univariate and multivariate regression analyses were used to generate odds ratios (ORs) and 95% confidence intervals (CIs). |