Abstract
OBJECTIVES: Inconsistent condom use (ICU) during anal sexual activity among men who have sex with men (MSM) can result in infection with HIV and other sexually transmitted infections (STIs). This study aimed to provide a scientific foundation for developing effective HIV prevention and control strategies for this population by analysing the prevalence of ICU and associated factors during anal sexual encounters among MSM recruited online. DESIGN: A cross-sectional online survey was performed. SETTING AND PARTICIPANTS: MSM were recruited online through a non-governmental organisation in May 2024 and completed a questionnaire survey in China. PRIMARY AND SECONDARY OUTCOME MEASURES: Based on whether the participants used condoms during anal sex with male partners, they were divided into two groups (ICU and non-ICU). Univariate and multivariate logistic regression analyses were used to analyse the factors associated with ICU. RESULTS: A total of 604 participants were analysed, of whom 400 (66.2%) reported ICU during anal sexual activity with homosexual partners. Multivariate logistic regression analysis indicated that participants who engaged in behaviours such as drinking alcohol, using drugs or taking performance-enhancing medications were more likely to have ICU during encounters with homosexual partners (adjusted OR (aOR) 2.93; 95% CI 1.64 to 5.47). Conversely, participants who had one-night stands (aOR 0.57; 95% CI 0.39 to 0.84), those with a self-efficacy score of 9 for condom use (aOR 0.47; 95% CI 0.29 to 0.77) and those who underwent HIV testing in the past year (aOR 0.39; 95% CI 0.21 to 0.68) were less likely to report ICU. CONCLUSIONS: A high proportion of participants reported ICU during sexual activity with homosexual partners. There is a need for education and awareness campaigns targeting MSM to promote consistent condom use during sexual activity, expand HIV testing coverage and discourage alcohol intake, drug use or use of enhancement medications during sexual encounters with homosexual partners to reduce the risk of contracting HIV and other STIs.