A total of 650 participants provided information about the use of condoms during anal sex with male partner(s) in the past month and condom was estimated to be used every time among 56.4% of this population during MSM anal sex in the previous month whereas 5.1% of the population was estimated by RRT as “never used condoms” during MSM anal sex in the same period. The results from the analysis of consistent condom use in the past month are presented in Table 4.
Subgroup analyses for each model were carried out based on participants’ demographic characteristics. Younger MSM participants (<30 years) had earlier first homosexual encounter (19.8 years) and slightly more male partners (3.0) in the past month than participants aged ≥30 years (24.4 years, 2.8, respectively). The proportions of consistent condom use (i.e., every time) in the past month and at most recent anal sex were lower in younger participants (53.8% and 78.1%, respectively) than older participants (60.2% and 82.7%, respectively).
The RRT estimate of age at the first sexual encounter with a male partner in our study is 21.7 years, which is younger than that reported by a study using a direct interview with an anonymous questionnaire in a cross-sectional survey of the MSM population in eastern China. A case–control study on the MSM population in southwestern China reported that the average age at the first sexual encounter with a man among the HIV-positive cases was 21.7 years, compared with 22.0 years among the HIV-negative controls. Our estimate of the age related to MSM debut homosexual encounter using RRT is the same as that for the HIV-positive cases, but slightly younger than that for the HIV-negative controls reported in the case–control study.
For the number of male sex partners in the past month, our RRT estimate is 2.9. A study among migrant MSM in Beijing reported that the median number of male sex partners was 3 in the past 6 months, which is close to our estimate but the reporting period is much longer than that of our study. Other studies reported more sex partners among Chinese MSM population in the period of the past 6 months before the survey. An online survey conducted among MSM in Beijing reported that the median number of male sex partners in the past 6 months was 5 whereas the overall median number of male sex partners of Chinese MSM in the past 6 months was estimated to be 1.5 by a review article based on the studies published during 2000–2010. In addition to the difference in reporting period, some studies were conducted several years earlier than the current study and the pattern of sexual behavior among MSM population may have changed with time.
Moreover, the risks of the behavioral characteristics investigated in this study were consistently higher in MSM aged <30 years (i.e., having earlier first sexual encounter, more number of sex partners and lower rate of consistent condom use in the past month, and lower rate of condom use at most recent anal sex) than older MSM. Nonetheless, such phenomenon was not observed in this population for other demographic features such as marital status (single vs. married), residence (Beijing resident vs. non-Beijing resident), length of residence in Beijing (<2 years vs. ≥ 2 years), ethnicity (Han vs. minorities), and education (high school or below vs. college or above). For these above mentioned demographic characteristics, the risks were higher in a subpopulation for some but not all behavioral characteristics under studied. This suggests that younger MSM population (aged <30 years) may be a priority target for intervention programs aiming to reduce the risk behaviors investigated by our study.
In summary, this study explored the profile of risk behaviors among MSM population in Beijing by employing a questionnaire with RRT in a sample of participants. Compared with the survey using anonymous questionnaires or direct interviews, the MSM population in the current survey using RRT started their first sexual encounter at a younger age had more male partners and lower rate of consistent condom use during anal sex with male partners, especially in younger MSM aged <30 years. These results suggest that RRT might be a useful tool to obtain more truthful feedback on sensitive information such as sexual behavior from the respondents. Meanwhile, RRT might be particularly valuable in traditional Chinese settings where MSM are trying to avoid the stigma incurred and, therefore, incline to respond evasively to conventional direct questionnaires or interviews.
However, a number of limitations of the present study are worthy of identifying. The participants of the study were recruited through peer-referrals and internet advertisements which may result in a sample with limited representativeness and reflect the difference of RRT estimate as compared to the estimate using conventional survey techniques. Moreover, we did not collect the data using a direct questionnaire simultaneously and thus could not compare the results from the direct questionnaire and that from RRT in the same study population. Besides, due to the nature of RRT, participant-level data are not available from the RRT survey and, therefore, preclude more detailed analysis based on individual data.
This work was supported by the National Natural Science Foundation of China (No. 81273188) and the Priority Academic Program Development (PAPD) of Jiangsu Higher Education Institutions.
There are no conflicts of interest.
The authors are indebted to the 659 MSM for their voluntary participation in the study and would like to thank Dr. Timothy Ng for polishing the language of the draft.
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Edited by: Qiang Shi