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A pilot intervention to increase condom use and HIV testing and counseling among men who have sex with men in Anhui, China
Global Health Sciences Literature Digest
Published August 30, 2010
Journal Article

Zhang H, Zunyou W, Yingjun Z, et al. A pilot intervention to increase condom use and HIV testing and counseling among men who have sex with men in Anhui, China. J Acquired Immune Defic Synd. 2010 Feb;53(Supp1):S88-S92.

In Context

HIV infections among men who have sex with men (MSM) in China accounted for approximately 7.3% of the 650,000 estimated HIV infections in China in 2005 and increased to 11% in 2007.(1, 2) Prevalence of HIV among MSM may be as high as 16.9%.(3) The risk appears to be high, with many of these MSM reporting unprotected anal and oral sex , commercial sex, and low rates of condom use.(4, 5) Although HIV testing is available, most MSM in China are unaware of their status.(4, 5, 6)


To increase condom use and HIV testing and decrease the number of partners among MSM


Three cities in Anhui Province, China

Study Design

Respondent-driven sampling for participation in a non-randomized behavioral intervention


Male adults (18 years and older), who reported sex with men in the past year and living in one of the three study cities for the duration of the study


Changes in the rates of HIV testing, unprotected anal sex in the prior two months, condom use with past three episodes of anal sex, having two or more male partners in the past two months, and having one or more casual male partners in the past two months.


MSM were recruited by having 12 MSM "seeds" who received training in leadership skills refer up to three peers, who in turn recruited an additional three peers until the sample of 218 was enrolled. Each intervention group consisted of the initial seeds and the referral network that resulted.

The intervention was led by the initial seed and consisted of four 1.5 hours sessions that included role-play, games, group discussions, brain storming, and competitions to test knowledge. The first session focused on understanding high-risk behavior. In session two, participants developed an individual plan to change their risk behaviors. The third session focused on taking action for behavior change. The last session addressed ways to deal with barriers to safe sex.


The mean age of participants was 25.5 years. Sixty-two percent were homosexual, 22.5% bisexual, 0.9% were heterosexual, and the remainder were undecided. All subjects participated in the first two sessions and 75.2% attended the third and fourth sessions. Nearly 80% of the participants were followed-up three months after the end of the intervention.

The rate of HIV testing increased from 15.1% to 52.4%. (P<0.01) Condom use improved, with the 25% who reported never using condoms declining to 9.4% (P<0.01). The proportion of participants who reported consistent use of condoms with the past three episodes of anal sex increased from 49.8% to 59.8% (P<0.01). The number of male partners reported by the participants did not change. Changes in these indicators from baseline to follow-up only among the 170 participants who were followed through three months post-intervention had similar results.


The intervention was effective at increasing condom use and HIV testing but not in reducing the number of male partners

Quality Rating

As an intervention study, the quality was limited by lack of randomization and a control group. Measures were by self-report and might not be valid. As a pilot feasibility study, however, it shows promise.

Programmatic Implications

The findings from this study suggest 1) that using members of the target group to recruit peers to participate in an intervention is feasible; 2) that a four-session intervention is acceptable (although loss to follow-up increased after the second session); and 3) that a peer-led intervention is effective at changing high-risk behavior and increasing HIV testing. That the intervention did not reduce the number of male partners may not be important in terms of HIV transmission if condoms are always used. Although these findings are encouraging, the intervention should be tested in a randomized controlled trial.


  1. Chinese Ministry of Health, Joint United Nations Programme on HIV/AIDS, World Health Organization. 2005 Update on the HIV/AIDS Epidemic and Response in China. Beijing, China: National Center for AIDS/STD Control and Prevention, China CDC; January 24, 2006.
  2. State Council AIDS Working Committee Office, UN Theme Group on AIDS in China. Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007). Beijing, China: State Council AIDS Working Committee Office; December 1, 2007.
  3. Annual report of Chongqing 2007. Fund Agency, the Fifth Round, China Programs for the Global Fund to Fight AIDS. Abstract not available.
  4. Zhang BC, Li XF, Shi TX, et al. Survey on the high risk behavior and other AIDS/STIs related factors among gay men in mainland China. Chin J Dermatol 2002;35:214-6. Abstract not available.
  5. Liu H, Liu Y, Xiao Y, et al. A survey on knowledge, attitude, belief and practice related to HIV/AIDS among MSM. Chin STD/AIDS Prev Cont 2001;7:289-91. Abstract not available.
  6. Xu J, Zhang HB, Zheng YJ, et al. Demand and use of VCT service among MSM. Chin J Public Health 2007;23:1040-2. Abstract not available.