Background Men who have sex with men (MSM) are a high-risk group for HIV, with marked heterogeneity in sexual behaviors. However, MSM are often treated as a homogeneous population, limiting the effectiveness of targeted HIV prevention strategies. This study aimed to compare sociodemographic characteristics, health cognition, and sexual risk behaviors between men who have sex with men only (MSMO) and men who have sex with men and women (MSMW) in Zhejiang Province, Eastern China. Methods This cross-sectional study was conducted among MSM in Zhejiang Province between July and December 2023. Participants were recruited through online channels and convenience sampling via non-governmental organizations (NGOs), and completed an anonymous online questionnaire. Bivariate analyses and multivariable logistic regression were used to identify factors associated with MSMW compared with MSMO. Results A total of 7,629 participants were included, comprising 5,964 MSMO and 1,665 MSMW. Compared with MSMO, MSMW were more likely to be married or cohabiting (adjusted odds ratio aOR: 2.38, 95% Confidence Interval CI: 1.68–3.37), report first-time HIV testing (aOR: 1.62, 95% CI: 1.36–1.92), and identify as having versatile (aOR: 9.56, 95% CI: 7.51–12.16) or insertive (aOR: 3.87, 95% CI: 3.01–4.99) sexual roles. MSMW also demonstrated significantly lower awareness of post-exposure prophylaxis (PEP) (aOR: 0.77, 95% CI: 0.64–0.94) and monkypox (MPOX) (aOR: 0.70, 95% CI: 0.59–0.82), as well as lower rates of consistent condom use (aOR: 0.58, 95% CI: 0.51–0.66). Conclusion MSMW in Zhejiang Province represent a distinct subgroup with a unique risk profile characterized by gaps in health cognition, specific sexual behavior patterns, and inconsistent condom use. These findings underscore the need for subgroup-specific HIV prevention strategies that move beyond one-size-fits-all approaches and better address the vulnerabilities of MSMW to reduce HIV and STI transmission.
He et al. (Wed,) studied this question.