title: Risky sexual networks and concentrated HIV epidemics among men who have sex with men in Wenzhou, China: a respondent-driven sampling study.
abstract: BACKGROUND
  The high and continually increasing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases among men who have sex with men (MSM) in China underscores the critical importance of examining the exact sexual networks that result in HIV transmission, as well as HIV infection, using powerful sampling methods, such as respondent-driven sampling (RDS), to improve the sexual health of this population.
  
  
  METHODS
  Using RDS, a cross-sectional study was conducted among MSM in Wenzhou, Zhejiang province, China from December 2013 to June 2014. The type of sex, numbers of anal sex partners, male oral sex partners and vaginal sex partners, condom use during each type of sex over the previous 6 months, prevention behaviors, risk perception, and the burdens of HIV and syphilis were investigated and analyzed.
  
  
  RESULTS
  Of 424 MSM, a great number of them did anal sex, male oral sex, and vaginal sex during the previous 6 months, and weighted estimates for the prevalence that MSM did not conduct these sexual behaviors were 11.2 % (95 % confidence interval [CI] =6.7-16.50 %), 20.3 % (95 % CI = 15.2-27.1 %), and 58.9 % (95 % CI = 52.1-65.8 %), respectively. Multiple sexual partners, engaging in regular, casual and commercial sex, and lack of condom use during all types of sex were common among MSM. The estimated HIV and syphilis prevalences were 22.8 % (95 % CI = 16.9-28.5 %) and 9.7 % (95 % CI = 6.4-13.6 %), respectively. Of the participants, 53.5 % (95 % CI = 45.3-60.2 %) received HIV-related interventions during the previous year, 48.1 % (95 % CI = 39.7-55.1 %) had never been tested for HIV, and only 14.1 % (95 % CI =10.1-19.2 %) perceived a risk of contracting HIV. Multiple logistic regression analysis revealed that age over 44 years (adjusted odds ratio [AOR] = 3.60, 95 % CI = 1.34-9.64), a monthly income of 3001-4000 yuan (approximately 470-630 US$) (AOR = 1.96, 95 % CI = 1.67-3.60), multiple anal sex partners (AOR = 1.93, 95 % CI = 1.15-3.24), awareness of the possibility of contracting HIV (AOR = 3.18, 95 % CI = 1.56-6.48), and current syphilis infection (AOR = 3.01, 95 % CI = 1.44-6.29) were predictors of HIV infection.
  
  
  CONCLUSIONS
  HIV transmission has become highly prevalent and will likely become more prevalent among MSM and their female partners if these risky sexual networks persist. Our findings call for urgent and effective interventions to prevent the rapid transmission of HIV among MSM in Wenzhou.
authors.affiliation: Department of HIV/STD Control, Center for Disease Control and Prevention of Zhejiang Province, No.3399, Binsheng Road, Hangzhou, 310051, People's Republic of China. qiaoqinma@aliyun.com.
authors.forename: Qiaoqin
authors.initials: Q
authors.lastname: Ma
authors.affiliation: Center for Disease Control and Prevention of Wenzhou Municipality, Wenzhou, 3250051, People's Republic of China. zsdcdc@126.coml.
authors.forename: Shidian
authors.initials: S
authors.lastname: Zeng
authors.affiliation: Department of HIV/STD Control, Center for Disease Control and Prevention of Zhejiang Province, No.3399, Binsheng Road, Hangzhou, 310051, People's Republic of China. Shchxia@cdc.zj.cn.
authors.forename: Shichang
authors.initials: S
authors.lastname: Xia
authors.affiliation: Department of HIV/STD Control, Center for Disease Control and Prevention of Zhejiang Province, No.3399, Binsheng Road, Hangzhou, 310051, People's Republic of China. xhpan@cdc.zj.cn.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Pan
authors.affiliation: Center for Disease Control and Prevention of Wenzhou Municipality, Wenzhou, 3250051, People's Republic of China. wdychn@163.com.
authors.forename: Dayong
authors.initials: D
authors.lastname: Wang
authors.affiliation: Center for Disease Control and Prevention of Lucheng District, Wenzhou, 325001, People's Republic of China. 490051406@qq.com.
authors.forename: Haishen
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of HIV/STD Control, Center for Disease Control and Prevention of Zhejiang Province, No.3399, Binsheng Road, Hangzhou, 310051, People's Republic of China. huiwang@cdc.zj.cn.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of HIV/STD Control, Center for Disease Control and Prevention of Zhejiang Province, No.3399, Binsheng Road, Hangzhou, 310051, People's Republic of China. ttjiang@cdc.zj.cn.
authors.forename: Tingting
authors.initials: T
authors.lastname: Jiang
authors.affiliation: Department of HIV/STD Control, Center for Disease Control and Prevention of Zhejiang Province, No.3399, Binsheng Road, Hangzhou, 310051, People's Republic of China. lhe@cdc.zj.cn.
authors.forename: Lin
authors.initials: L
authors.lastname: He
authors.affiliation: Center for Disease Control and Prevention of Lucheng District, Wenzhou, 325001, People's Republic of China. 351515007@qq.com.
authors.forename: Dongshe
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Nanjing Medical University School of Public Health, Nanjing, 211166, People's Republic of China. zhihangpeng@163.com.
authors.forename: Zhihang
authors.initials: Z
authors.lastname: Peng
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D021841:Safe Sex; D012494:Sampling Studies; D011477:Sex Work; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000453:epidemiology; D055815:Young Adult