A total of 7,391 participants were recruited via the Blued APP and the college associations, of which 438 (5.9%) did not provide informed consent. 6,953 (94.1%) potential participants were screened and completed the online survey. Among them, 1,459 (21.0%) had not had sexual intercourse with men in their lifetime and 2,490 (35.8%) were not aged between 18–25 years old. A total of 3,004 (43.2%) were included in the final study.
Participants
Among the 3,004 study participants, a little less than half (1,390, 46.3%) were students, while 1,614 (53.7%) were non-students (Table 1). The majority of participants identified as homosexual (79.8%), single (70.1%), perceived the risk of HIV infection (83.9%), and were willing to communicate with people living with HIV (60.1%). A greater proportion of student YMSM had more knowledge of HIV-related factors (59.1% versus 54.2%, P = 0.007). As seen in Table 1, there were statistically significant differences between student and non-student YMSM in regards to sexual risk behaviors including unprotected insertive intercourse, number of sexual partners, and condom use. A larger number of non-student YMSM had unprotected, insertive sexual intercourse ever in their lifetime (74.0% versus 62.8%, P<0.001), while a greater proportion of student YMSM reported always using condoms with sex partners in the past six months (70.0% versus 64.4%, P = 0.003). Additionally, a more non-student YMSM had two or more sex partners in the past six months (48.8% versus 41.2%, P<0.001), while a larger number of student YMSM had a stable sex partner in the past 6 months. In regards to HIV testing behaviors, more non-student YMSM had HIV testing in their lifetime (71.5% versus 64.4%, P<0.001).
The general HIV-related knowledge among all participants is summarized in Table 2. The overall score of HIV-related knowledge of the two groups was 75.75±16.05 out of 100. As shown in Table 2, the average score of HIV-related knowledge for student YMSM was 77.38±14.65, while it was somewhat lower for non-student YMSM, at 74.34±17.03. Awareness of HIV-related knowledge was statistically different between the student and non-student groups on a handful of questions. More students answered correctly on questions related to infection route and reducing risk behaviors (“is it possible to get infected with HIV by eating with people whom have HIV? 97% vs. 94.3%, P<0.001; which of the following behaviors can effectively reduce the risk of HIV infection? 73.3% vs. 64.1%, P<0.001). However on one question, “do other STDS increase the risk of HIV infection?”, more non-student YMSM answered correctly than student YMSM (67.5% versus 61.4%, P<0.001).
[Insert Table 1 here - Table 1. Characteristics of all participants on and off campus]
[Insert Table 2 here - Table 2. Awareness of HIV-related knowledge]
Stratified analysis of HIV infection
A total of 2,049 (68.2%) YMSM had ever been tested for HIV, including 895 students and 1,154 non-students (Table 3). The overall HIV infection rate in the study was 8.1%, with a statistically higher prevalence amongst non-student YMSM (10.3%) compared to student YMSM (5.3%), (χ2trend = 17.34, P<0.001).
The HIV infection rate among student YMSM and non-student YMSM was significantly different by sexual orientation (χ2 = 15.55, P<0.001), risk perception of HIV infection (χ2 = 19.65, P<0.001), unprotected, insertive sexual intercourse ever in lifetime (χ2 = 13.47, P<0.001), sex partners (χ2 = 7.56, P = 0.006; χ2 = 10.18, P<0.001) and HIV testing in the past six months (χ2 = 18.19, P<0.001).
[Insert Table 3 here - Table 3. Stratified analysis of HIV infection.]
Factors associated with HIV infection
As shown in Table 4, non-students (AOR = 2.12, 95%CI = 1.42–3.19, P<0.001), self-identifying as homosexual (AOR = 2.81, 95%CI = 1.40–5.66, P = 0.004) YMSM were at increased odds of being HIV positive. Those whom perceived the risk of HIV infection (AOR = 3.08, 95%CI = 1.33–7.15, P = 0.009) were also at increased odds of being HIV positive. Additionally, YMSM whom reported not always using condoms with sex partners in the past six months (AOR = 1.69, 95%CI = 1.17–2.44, P = 0.006) had higher odds of HIV infection. YMSM population whom reported never having unprotected insertive sexual intercourse in their lifetime had reduced odds of HIV infection (AOR = 0.16, 95%CI = 0.07–0.37, P<0.001).
[Insert Table 4 here - Table 4. Factors associated with HIV infection.]