Identifying patterns of sexual behaviors on HIV testing and PrEP uptake among MSM in China: A latent class analysis

Background Men who have sex with men (MSM) in China are at risk of HIV, and a low pre-exposure prophylaxis (PrEP) uptake. This study examined HIV testing and PrEP-related behaviors by sexual behavior profiles amongst MSM. Methods A total of 486 sexually active, HIV negative/unknown MSM (Median age: 26 years; (IQR: 23-34) were included. Latent class analysis (LCA) identified behavior patterns based on condomless sex, numbers of male sex partners, group sex, commercial sex, and sexualized drug use. Associations with demographics, HIV testing, and PrEP uptake were examined. Results Four classes were identified: reserved (34%), selective (36%), safe players (14%), and unrestrained (16%). The unrestrained showed the highest sexualised drug use (62%), binge drinking (22%), and PrEP use (27-40%). Safe players had high HIV testing rates (89%) but lower PrEP use compared to the unrestrained . Over one-quarter of the reserved had not tested for HIV in the past year, with similarly low PrEP uptake. S elective participants had HIV testing ≥5 times in the past year (21%), preferred self-testing (75%), and had a ∼30% PrEP uptake. Across all classes, >82% preferred direct PrEP delivery (rather than clinic collected). The top three barriers to accessing PrEP were; cost (45%), concerns about side effects (41%), and lack of knowledge about where to obtain PrEP (34%). Conclusions Distinct behavioral profiles indicate the need for tailored prevention strategies integrating education and accessible PrEP delivery.