Objective:To understand the source and related factors among heterosexual casual partners among male college students for providing AIDS prevention strategies in this population.Methods:Stratified cluster sampling method was used to conduct a questionnaire survey among 31 674 college students in 13 colleges in Zhejiang Province, from October to November, 2018. A total of 2 665 male college students who reported having had heterosexual casual behavior and the source of their sexual partners were recruited. Data on demographic characteristics, knowledge of HIV/AIDS prevention, sexual behavior, and having received AIDS-related interventions were collected. The multivariable logistics regression model was used to analyze the related factors of the source of casual heterosexual behavior partners among male college students.Results:A total of 423 male college students having casual heterosexual sex were investigated, accounting for 15.9% (423/2 665) of the male college students who self-reported having sexual behaviors and informed their sexual partners. Among them, 39.4% (147/373), 37.5% (140/373), and 23.1% (86/373) of participants had 1, 2-4, and 5 or more heterosexual casual sexual partners, respectively. 40.1% (167/416) of participants used condoms consistently with casual partners. 143 (33.8%) participants with social individual's partners were an average age of (20.27±1.40) years old. Multivariate logistic regression analysis showed that: when compared with one person, common acquaintances, and no heterosexual casual partners in the previous year, the factors that related to the source of heterosexual casual partners of male college students appeared as follows: the number of heterosexual casual sexual partners ≥5 (a OR=3.00, 95% CI:1.53-5.89), seeking the casual sexual partners through entertainment venues (a OR=3.04,95% CI:1.64-5.64), male college students having sex with a regular partner in the last one year (a OR=0.41, 95% CI:0.25-0.68). Conclusions:Some of the male college students had heterosexual casual sexual behaviors, with the related factors as having five or more heterosexual casual sexual partners, seeking casual sex partners through entertainment venues, and low condom use. Self-protection awareness and ability should be emphasized to advocate safe sex to reduce the risk of AIDS transmission among college students.

Objective:To investigate the prevalence of syphilis in HIV-infected patients with transmission risk and influencing factors in Zhejiang Province.Method:The information about the HIV-infected patients, who were alive, had been diagnosed with HIV for >1 year, had received no antiviral treatment or had HIV viral load ≥50 copies/ml, and were aged ≥15 years, reported in Zhejiang as of December 31, 2018 were collected from China Information System for Disease Control and Prevention. The information included general demographic characteristics, sexual behavior characteristics and antiretroviral therapy and syphilis serological test results. The prevalence of syphilis and the influencing factors were analyzed by logistic regression model. The SPSS 19.0 software was used for statistical analysis.Results:A total of 2 275 HIV-infected patients were at risk of HIV transmission, and 75.5% (1 717/2 275) of them were tested for syphilis, the prevalence rate of syphilis was 8.7% (150/1 717). Among the HIV-infected patients with syphilis, 11.3% (17/150) received no antiviral treatment, 38.7% (58/150) had viral load of 50-999 copies/ml and 50.0% (75/150) had ≥1 000 copies/ml. Multivariate logistic regression analysis showed that being men (a OR=2.04, 95% CI:1.06-3.96), homosexual transmission (a OR=1.53, 95% CI:1.04-2.27), history of sexually transmitted diseases (STDs) before HIV diagnosis (a OR=1.98, 95% CI:1.35-2.92) and HIV viral load ≥1 000 copies/ml (a OR=1.90, 95% CI:1.09-3.30) were the risk factors for syphilis. Marriage (a OR=0.47, 95% CI: 0.29-0.76) was a protective factor for syphilis. Conclusions:The prevalence of syphilis was high in HIV-infected patients with transmission risk in Zhejiang. It is urgent to carry out classified management and targeted intervention in HIV-infected patients, explore multi-disease prevention and treatment mechanism, strengthen syphilis screening and treatment in HIV-infected patients to reduce the transmission of HIV and syphilis.

Objective : To analyze the problems in the AIDS control strategy in key areas of Zhejiang Province, so as to provide insights into the improvement of the control strategy. Methods : The AIDS control data were collected from 10 key counties (districts) in Zhejiang Province, and the AIDS control strategy was comprehensively evaluated using a SWOT analysis. Results : The strengths of the AIDS control strategy in key counties (districts) of Zhejiang Province included distinct working objectives, well-organized leadership, and effective control measures, the weaknesses included large number of HIV-infected cases, high burden of disease, difficulty in management of AIDS transmission and insufficient AIDS control capability, and the opportunities included the AIDS control in key counties (districts) conforming to the current status of AIDS control, strong support of innovative strategies and technical support from professional teams, while the threats included insufficient working mechanisms for AIDS control, the gap between the effectiveness of AIDS control and the target goal and unverified scientific evidence of the control strategy. Supported policies should be fully used, working mechanisms need to be improved, control strategies need to be innovated, and assessments need to be implemented for AIDS control in key counties (districts). Conclusions There are both opportunities and challenges for AIDS control in key counties (districts) of Zhejiang Province. Optimization of the working mechanisms, promotion of precision interventions, and search for repeatable control strategy in other disease-affected regions are required for AIDS control.

Objective: To investigate the factors affecting HIV testing among male college students with sexual behaviors, so as to provide the evidence for improving the detection of HIV testing among young college students. Methods: Four undergraduate universities and one junior college were randomly sampled from Hangzhou City using a purposive sampling method during the period between September and November, 2021, and male students with self-reported sexual behaviors were recruited as study students. Participants' demographics, AIDS-related knowledge, sexual behaviors and HIV testing were collected using questionnaires, and factors affecting HIV testing using a multivariable logistic regression model. Results: A total of 720 male college students with sexual behaviors were enrolled, including 180 freshmen (25.00%), 178 sophomores (24.72%), 163 juniors (22.64%), 50 seniors (6.94%) and 149 postgraduates (20.69%), and 94 students received HIV testing (13.06%), including 57.45% receiving self-testing. Multivariable logistic regression analysis identified postgraduates (OR=0.302, 95%CI: 0.127-0.719), sexual orientation (homosexual, OR=0.090, 95%CI: 0.028-0.294; bisexual/uncertain, OR=0.181, 95%CI: 0.066-0.495), awareness of HIV testing (low awareness, OR=0.411, 95%CI: 0.176-0.957; moderate awareness, OR=0.305, 95%CI: 0.123-0.757; high awareness, OR=0.087, 95%CI: 0.032-0.235) as factors affecting HIV testing among male college students with sexual behaviors. Conclusions The prevalence of HIV testing correlates with awareness of HIV testing among male college students with sexual behaviors. Improvements in health education of HIV testing and accessibility of HIV testing services are recommended.

Objective: To investigate the characteristics of temporary heterosexual behaviors among male college students through Internet dating, so as to provide insights into HIV/AIDS control among young college students. Methods: A total of 15 universities/colleges were sampled from Zhejiang Province using a stratified cluster sampling method, and 3 schools/departments were sampled from each university/college. Male college students with temporary heterosexual behaviors during the past year were recruited. Participants' demographics, AIDS-related knowledge, compliance to HIV/AIDS interventions, Internet dating and sexual behaviors were collected, and the characteristics of male college students with Internet dating were analyzed. Results : A total of 326 students were enrolled, including 202 participants from regular institutions of higher education (61.96%) and 124 students from higher vocational colleges (38.04%). There were 79 freshmen (24.23%), 99 sophomores (30.37%), 104 juniors (31.90%) and 44 seniors (13.50%), and there were 100 participants (30.67%) with temporary heterosexual behaviors through Internet dating during the past year. Among the 100 participants, there were 75.00% of participants knowing “man who have sex with man is the main transmission pattern of AIDS among young students in China”, 93.00% knowing “insisting on accurate use of condoms may reduce the risk of HIV infections and transmission” and 93.00% knowing “seeking HIV testing and counseling actively following high-risk behaviors”. There were 77 participants (77.00%) with students as their temporary heterosexual partners, 17 participants (17.00%) that had received HIV self-testing and 17 participants (17.00%) that had received HIV testing in medical institutions, 22 participants (22.00%) that had never used condoms during temporary heterosexual behaviors during the past year, and 29 participants (29.00%) with commercial sexual behaviors during the past year. In addition, male college students with temporary heterosexual behaviors through Internet dating were more unlikely to use condoms and more likely to have commercial sexual behaviors than those with dating through other ways (P<0.05). Conclusions Male college students with temporary heterosexual behaviors through Internet dating are more likely to have high-risk sexual behaviors than those with dating through other ways. Internet-based mobile sexual education and HIV/AIDS health education are recommended.

Objective : To investigate the factors affecting multiple sexual partner behaviors among men who have sex with men (MSM) at ages of 16 to 24 years in Zhejiang Province, so as to provide the evidence for formulating the integrated interventions for HIV/AIDS among adolescents. Methods : The demographic features, sexual behaviors and HIV testing were collected from MSM at ages of 16 to 24 years in Zhejiang Province through the Management Information System of China AIDS Fund for Non-governmental Organizations (CAFNGO) in 2021. The factors affecting multiple sexual partner behaviors were identified among MSM at ages of 16 to 24 years using a multivariable logistic regression model. Results : A total of 1 253 participants were enrolled, with a mean age of (21.16±2.06) years. There were 1 219 unmarried respondents (97.29%), 807 (64.61%) with diploma and above, 250 (19.95%) with multiple sexual partners during the past 3 months, 344 (27.45%) with unprotected sexual behaviors in the past 3 months, 71 (5.67%) that had used rush or new drugs, 511 (40.78%) that were unaware of their sexual partners' HIV infections, 28 (2.23%) with symptoms or diagnosis of sexually transmitted diseases, and 35 (2.79%) with positive HIV testing. Multivariable logistic regression analysis identified age (19 years-, OR=2.563, 95%CI: 1.404-4.679; 22 to 24 years, OR=2.149, 95%CI: 1.180-3.913), having unprotected sexual behaviors in the past 3 months (OR=5.338, 95%CI: 3.938-7.237), having used rush or new drugs in the past 3 months (OR=3.669, 95%CI: 2.142-6.286), unaware of sexual partners' HIV infections(OR=1.402, 95%CI: 1.032-1.903), and positive HIV tests (OR=2.763, 95%CI: 1.298-5.880) as factors affecting multiple sexual behaviors among MSM at ages of 16 to 24 years. Conclusions The multiple sexual behaviors correlate with age, unprotected sexual behaviors, use of rush or new drugs and unawareness of sexual partners' HIV infections among MSM at ages of 16 to 24 years.

Objective:To analyze the willingness of post-exposure prophylaxis (PEP) to prevent HIV transmission and related factors in men who have sex with men (MSM).Methods:Cross sectional survey design was used in this study. After informed consent, MSM aged 18 years or above and having had homosexual anal or oral sex in the past 6 months were recruited through "i WeChat" official account between September and November, 2019.Results:Of 1 517 MSM were surveyed, the proportion of MSM who had ever heard of PEP were 72.5% (1 100/1 517) and 87.9%(1 333/1 517) of the MSM said they would like to use PEP if it is needed.Multivariate logistic regression analysis suggested that aged above 25 year ( OR=1.807, 95% CI: 1.090-2.995), HIV test history ( OR=1.953, 95% CI: 1.171-3.256) and being aware of PEP ( OR=2.163, 95% CI: 1.468-3.186) were the positive factors for PEP use, but an aware of the HIV status of sexual partner was the negative factor for PEP ( OR=0.602, 95% CI: 0.407-0.890). Among MSM who had ever heard of PEP, the positive factors for PEP use included living in Zhejiang ( OR=1.942, 95% CI: 1.097-3.438), aged above 25 years ( OR=2.431, 95% CI: 1.331-4.439), being aware of PEP ( OR=3.714, 95% CI: 1.532-9.007) obtaining information about PEP service from MSM organization/volunteer/health organization. Conclusions:MSM's willingness to use PEP services was relatively high. Age, awareness of PEP related knowledge, and awareness of sexual partner's HIV infection status were the related factors. MSM organization/volunteer/health organization were the main forces for PEP promotion in MSM.

Objective:To analyze the prevalence of anal sex and related factors in low-tier female sex workers (FSWs) in the demonstration areas of comprehensive AIDS responses (DACAR) in Zhejiang province.Method:In 2013, a survey on low-tier FSWs was carried out in 21 Demonstration Areas of AIDS Responses in Zhejiang. Experience of having anal sex with clients in the last month was taken as dependent variable while independent variables would include perception and characteristics related to behavior of the FSWs. The multivariate logistic regression analyses were conducted to identify the factors related to anal sex in low-tier FSWs.Results:A total of 2 645 low-tier FSWs were interviewed. Among these FSWs, 67.9% (1 796/2 645) were over 26 years old, 89.9% (2 378/2 645) were with education level of junior high school or below, 58.4% (1 546/2 645) were married, 78.2% (2 068/2 645) were from other provinces, 68.6% (1 814/2 645) had income level less than 4 000 Yuan, and rates of anal sex with client in the last month were 5.03% (133/2 645). Results from the multivariate logistic regression analysis of related factors of anal sex with client in the last month showed that among the low-tier FSWs, the venues of having commercial sex were in hair salons/massage parlors ( OR=7.31, 95 %CI: 2.27-23.59), roadside shops ( OR=7.89, 95 %CI: 2.27- 27.40) or other places ( OR=4.65, 95 %CI: 1.23-17.53), when compared with the street-women service. FSWs often engaged in commercial sex business in three or more counties ( OR=1.68, 95 %CI: 1.01-2.81), when compared with FSWs often engaged in commercial sex business just one county. FSWs had sex with only middle-aged and the elderly clients ( OR=0.45, 95 %CI: 0.30-0.66), when compared with FSWs had sex with young or middle-aged and the elderly clients. FSWs had risk perception for sexually transmitted disease (STD) ( OR=2.00, 95 %CI: 1.20-3.32), when compared with FSWs with no risk perception. FSWs had oral sex experience with their clients in the last month ( OR=7.29, 95 %CI: 4.78-11.12), when compared with the ones without oral sex. The above said factors were all related to the incidence of anal sex. Conclusions:Certain numbers of low-tier FSWs had anal sex experiences with their clients, especially those who had oral sex were more likely to have anal sex in DACAR in Zhejiang province. Attention should be paid to anal sex behavior when conducting behavior-related intervention programs, targeting on the low-tier FSWs.

Objective: To understand the confidence-related factors of refusing unprotected sex behavior among college students in Zhejiang province. Methods: Stratified cluster random sampling method was conducted among college students from 13 colleges and universities in Zhejiang province, from October to November, 2018. A total of 3 718 students who self-reported "ever having had sexual contacts" were enrolled. Chi-square test was used to compare the confidence of rejecting unprotected sex under different demographic characteristics, sexual attitude/behaviors and different intervention approaches. Multivariate logistic regression model was used to analyze the related factors. Results: A total of 3 718 college students were involved in this study with average age as (20.17±1.38) years old and 70.5% (2 620/3 718) were male. The proportions of having confidence to refuse unprotected sex behavior were 74.9% (1 963/2 620) of male and 77.9% (896/1 098) of female students, respectively. According to the results from multivariate logistic regression analysis, factors that related to the confidence of refusing unprotected sex behavior in male students would include, did not accept casual sex behavior (compared with accepted students, OR=2.247, 95%CI: 1.828-2.762), did not accept homosexual behavior (compared with accepted students, OR=1.810, 95%CI: 1.302- 2.516), having casual sex behavior in the past one year (compared with having no sex behavior, OR=1.345, 95%CI: 1.051-1.721), aware of the availability of HIV self-test reagents service in college (compared with did not knew, OR=1.381, 95%CI: 1.011-1.887), having taken the HIV infection risk self-assessment in college (compared with did not take, OR=1.707, 95%CI: 1.374-2.121). In female students, the factors would include: being urban resident (compared with rural residence, OR=1.816, 95%CI: 1.225-2.693), 21 years old or above (compared with 20 years old or below, OR=1.469, 95%CI: 1.075-2.007), having taken the HIV infection risk self-assessment in college (compared with did not take, OR=1.597, 95%CI: 1.093-2.333), etc. Conclusions Both male and female college students had higher confidence in refusing unprotected sex behavior. For male students, refusing casual or homosexual contacts, having casual sex in the recent year, knowing HIV self-test reagents service and having had HIV-related risk self-assessment in college as related factors. However, for female students; city residence, 21 years old and above, and having a HIV infection risk self- assessment in college appeared as related factors. Sexual health education should be strengthened to reduce unprotective sex behavior and to promote HIV infection risk self-assessment among the college students.

Objective: To study oral sexual behavior and related factors among male students. Methods: The male students from college graduation in Hangzhou were selected as the study objects, and the inclusion criteria were having had sex and informed the type of behavior. A total of 490 subjects were finally included. Results: Among 490 male students, the 20-22 years old, 23 years old and 24-27 years old age groups accounted for 38.8% (n=190), 37.8% (n=185) and 23.3% (n=114), respectively. A total of 99 (20.2%) cases had oral sexual behavior, of which only 14 (2.9%) cases used condom. After adjusting for unplanned pregnancy, stage of sexual behavior, sexually transmitted diseases infection possibility, sexual orientation factors, normal/unnormal family relationship, more than 2 sexual partners, casual sexual partners, sexual partners from other college, sexual partners from society, sexual behavior in past 1 year were positively associated with oral sexual behavior. The corresponding OR (95%CI) values were 2.77 (1.40-5.50), 2.29 (1.27-4.15), 2.68 (1.23-5.88), 2.45 (1.34-4.48), 2.47 (1.15-5.33) and 2.04 (1.05-3.96), respectively. Use of condoms was negatively associated with oral sexual behavior, the OR (95%CI) value was 0.20 (0.09-0.42). Conclusion Normal/unnormal family relationship, more than two sexual partners, casual sexual partners, sexual partners from other college, sexual partners from society, sexual behavior in last one year and condom use in each vaginal sexual behavior were associated with oral sexual behavior.