HIV Prevention for Chinese Men Who Have Sex with Men

According to estimates, men who have sex with men (MSM) account for 2-4% of the sexually active male population in China, which translates to approximately 20-30 million individuals. This group also accounts for 11% of all people living with HIV/AIDS in China. Recent data suggests that homosexual transmission is on the rise, with 12.2% of the estimated 50,000 new HIV infections in 2007 attributed to this mode of transmission. A 2007 survey in Kunming estimated an HIV prevalence of 10% among MSM. The high risk of HIV transmission among MSM is attributed to various factors, including unprotected anal intercourse, multiple and overlapping male and female partners, high and increasing prevalence of sexually transmitted infections (STIs), and low rates of STI/HIV screening. A comparison of HIV prevalence among MSM in Asia reveals varying rates across different regions. In Thailand, for example, the prevalence was 17.3% in 2005, while in Beijing, it was 14.0% in 2004-2005. In contrast, the prevalence in Jakarta was 2.5% in 2002. The data suggests that if current trends continue, MSM incidence will outstrip all other risk groups by 2020. The Kunming Spring Rain MSM Workgroup has developed a comprehensive prevention package for MSM, which targets the highest risk populations and aims to avert the maximum number of infections. The package includes a range of services, including peer education, outreach, behavior change communication, STI services, HIV testing and counseling, and condom distribution. The initiative also recognizes the importance of creating an enabling environment to support MSM. A community-based intervention model has been implemented, which includes regular outreach in bars, parks, public toilets, and bathhouses, as well as a drop-in center with regular educational sessions and telephone hotline counseling. Referral to MSM-friendly HIV/STI clinical services is also provided. The initiative has been supported by various organizations, including FHI, KIHE, YNCDC, and PSI. The project has achieved significant outputs, including reaching and serving 4,644 MSM in Kunming from October 2008 to September 2009. The initiative has also provided STI services to 1,101 MSM and VCT services to 405 MSM. Roughly 9% of those covered by the project were tested for HIV and know their results, while the total loss to follow-up for VCT was 20%, compared to the national average of 28%.