HIV Prevalence and Correlates of Unprotected Anal Intercourse Among Men Who Have Sex with Men, Jinan, China

China’s HIV epidemic may be shifting towards predominantly sexual transmission and emerging data point to potential increases in HIV prevalence among men who have sex with men (MSM). There is particular need to assess the extent of risk behavior among MSM outside of China’s most cosmopolitan cities. We conducted a respondent-driven sampling survey (N = 428) to measure HIV seroprevalence and risk behavior among MSM in Jinan, China, the provincial capital of Shandong. HIV prevalence was 0.5% (95% confidence interval [CI] 0.1–1.0). Unprotected anal intercourse (UAI) in the last 6 months (reported by 61.4%) was associated with buying or selling sex to a man in the last 6 months, syphilis infection, multiple partners in the last month, low HIV knowledge and migrant status. No participant had previously tested for HIV. Risk for HIV transmission is widespread among MSM throughout China; basic prevention programs are urgently needed.     

Inconsistent Condom Use with Steady and Casual Partners and Associated Factors among Sexually-Active Men who Have Sex with Men in Bangkok, Thailand

HIV/STD risk behavior has not been examined in community samples of men who have sex with men (MSM) in Thailand. The sexually-active sample (n=927) was recruited from bars, saunas, and parks; 20% identified as bisexual and 17% tested HIV-positive. Inconsistent (<100%) condom use was reported by 45% of those with steady partners and 21% of those with casual partners in the prior three months. 21% had heard of effective HIV treatments (n=194), among whom 44% believed HIV was less serious and 36% said their risk behavior had increased after hearing about the treatments. In multivariate analysis, HIV-positive status, gay-identification, getting most HIV information from the radio, believing HIV can be transmitted by mosquito bite, and concern about acquiring an STD were associated with inconsistent condom use during anal sex; slightly older age (25–29 vs. 18–24 years) was associated with more consistent condom use. HIV/STD risk-reduction strategies for MSM in Bangkok should clearly state sexual risk to individuals in this population.     

Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men

HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. An online cross-sectional study was conducted among MSM in eight Chinese cities in July 2016. Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing (including HIV self-testing) history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. A minority (20.6%, 346/1678; 17.8%, 287/1608) of men received HIV serostatus disclosure from their most recent regular and casual male partners, respectively. Multivariate analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular [adjusted OR (aOR) = 1.92, 95% CI 1.50–2.44] and casual (aOR = 2.34, 95% CI 1.80–3.04) male partners compared to never self-tested participants. Compared to participants who had not received HIV status disclosure from regular partners, participants who received disclosure from regular male partners had higher likelihood in experiencing post-test violence (aOR = 5.18, 95% CI 1.53–17.58). Similar results were also found for receiving HIV serostatus disclosure from casual partners. This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.     

Impact of Condom Use and Standardized Sexually Transmitted Disease Treatment on HIV Prevention Among Men Who Have Sex with Men in Hunan Province: Using the Asian Epidemic Model

Abstract We evaluated the HIV/AIDS epidemic among men who have sex with men (MSM) in Hunan Province using the Asian Epidemic Model (AEM) and explored the impact of both condom use and standardized STD treatment on HIV prevention programs. The AEM was used to estimate HIV infection under four different scenarios: (1) condom use among MSM maintained at the 2005 level, (2) condom use among MSM improved since 2005, (3) the sexually transmitted infection (STI) prevalence rate among MSM maintained at the 2008 level, and (4) the STI prevalence rate among MSM improved since 2008. Compared with the rate of condom use at the 2005 level among MSM, if the rate of condom use had continuously improved, the number of new infections would have been reduced by 79.1% and the number of people living with HIV and AIDS would decrease by more than 8600 by 2020 and the cumulative number of new infections would have been reduced by 63.6% since 2006 while the number of new HIV infections among females would decline from 2015 with a drop of over 35% by 2020. When compared with the projection based on an unchanged rate of STI infection, the number of new HIV infections would decrease by 49.4% by 2020, and the decreased number of people living with HIV and AIDS would be more than 4000. The total number of 5200 newly infected HIV cases could be reduced from 2006 to 2020 and the number of newly infected HIV cases among the general female population would be reduced by 15.4%. With both the increased rate of condom use and standardized STD treatment for the MSM population in Hunan Province, the spread of HIV infection in both MSM and the general female population would decrease.     

Stable Sexual Risk Behavior in a Rapidly Changing Risk Environment: Findings from Population-Based Surveys of Men Who Have Sex with Men in Seattle, Washington, 2003–2006

We assessed trends in behavioral risk for HIV infection among men who have sex with men (MSM). Seattle MSM participated in random digit dial telephone surveys in 2003 (n = 400) and 2006 (n = 400). Fourteen percent in 2003 and 9% in 2006 reported unprotected anal intercourse with a partner of different or unknown HIV status (non-concordant UAI; odds ratio [OR] = 0.7; 95% confidence interval [CI]: 0.5, 1.2). Compared to participants in 2003, participants in 2006 met a greater proportion of their anal sex partners through the Internet (OR = 2.0; 95% CI: 1.2, 3.1). Although the proportion of anal sex partnerships formed online increased between 2003 and 2006, Internet partnerships were not more risky than those initiated elsewhere. While the emergence of the Internet as a venue through which men meet partners demonstrates that sexual risk among MSM remains highly dynamic, our findings suggest that sexual risk behavior among MSM is currently stable.     

The Association of Intimate Partner Violence,Recreational Drug Use with HIV Seroprevalence among MSM

Intimate partner violence (IPV) has been significantly associated with HIV among heterosexual individuals. Yet a similar relationship has not been so clearly described among men who have sex with men (MSM). The aim of this study was to investigate the association of IPV with HIV seroprevalence among MSM. Participants consisted of 7,844 MSM clients who visited the Whitman Walker Clinic in Washington DC from 2000 through 2007, the majority of whom were Caucasian with a median age of 30. The univariate analysis showed that self-reported IPV was significantly associated with HIV (OR: 1.67, CI: 1.14–2.45) among the sampled MSM clients. However, when adjusting for sexually transmitted infection (STI) status and self-reported risk behaviors including recreational drug use, condom use, number of male sex partners, and having sex with a positive HIV partner, the association of IPV with HIV was not statistically significant. Results indicated that the strong independent association of recreational drug use with HIV seroprevalence decreased the association of IPV with HIV significantly (with recreational drug use, OR: 1.36, CI: 0.93–2.00 vs. without recreational drug use, OR: 1.51, CI: 1.03–2.22).     

High HIV Prevalence Among Men Who have Sex with Men in Soweto,South Africa: Results from the Soweto Men’s Study

The Soweto Men’s Study assessed HIV prevalence and associated risk factors among MSM in Soweto, South Africa. Using respondent driven sampling (RDS) recruitment methods, we recruited 378 MSM (including 15 seeds) over 30 weeks in 2008. All results were adjusted for RDS sampling design. Overall HIV prevalence was estimated at 13.2% (95% confidence interval 12.4–13.9%), with 33.9% among gay-identified men, 6.4% among bisexual-identified men, and 10.1% among straight-identified MSM. In multivariable analysis, HIV infection was associated with being older than 25 (adjusted odds ratio (AOR) 3.8, 95% CI 3.2–4.6), gay self-identification (AOR 2.3, 95% CI 1.8–3.0), monthly income less than ZAR500 (AOR 1.4, 95% CI 1.2–1.7), purchasing alcohol or drugs in exchange for sex with another man (AOR 3.9, 95% CI 3.2–4.7), reporting any URAI (AOR 4.4, 95% CI 3.5–5.7), reporting between six and nine partners in the prior 6 months (AOR 5.7, 95% CI 4.0–8.2), circumcision, (AOR 0.2, 95% CI 0.1–0.2), a regular female partner (AOR 0.2, 95% CI 0.2–0.3), smoking marijuana in the last 6 months (AOR 0.6, 95% CI 0.5–0.8), unprotected vaginal intercourse in the last 6 months (AOR 0.5, 95% CI 0.4–0.6), and STI symptoms in the last year (AOR 0.7, 95% CI 0.5–0.8). The results of the Soweto Men’s Study confirm that MSM are at high risk for HIV infection, with gay men at highest risk. HIV prevention and treatment for MSM are urgently needed.     

Alcohol Use and Associated Sexual and Substance Use Behaviors Among Men Who Have Sex with Men in Moscow,Russia

Alcohol use is a public health problem in the Russian Federation. This study explored relationships between alcohol use and behavioral risks for HIV transmission among men who have sex with men (MSM) in Moscow, Russia. Alcohol use disorder identification test (AUDIT) scores for 1367 MSM participating in a cross-sectional survey and HIV testing were categorized to: “abstinence/low use”, “hazardous use”, “harmful use/dependency”. Multiple logistic regression models compared dependent variables for sexual and drug use behaviors across alcohol use strata. Hazardous and harmful/dependent alcohol use were significantly associated with high-risk sexual behaviors and drug use. Harmful use/dependency was associated with an increased odds of having more than five male sex partners (last 12 months; adjusted odds ratios—AOR 1.69; 95 % CI 1.25–2.27), inconsistent condom use during anal intercourse (AOR 2.19; 95 % CI 1.61–2.96) and, among those using recreational drugs, injection drug use (last month; AOR 4.38: 95 % CI 1.13–17.07) compared to abstinent/low-level users. Harmful/dependent use was marginally associated with HIV infection (AOR 1.48; 95 % CI 0.97–2.25). HIV prevention efforts for MSM in Moscow may benefit from addressing problem alcohol use to mitigate high-risk behaviors.     

Predictors of Unrecognized HIV Infection Among Poor and Ethnic Men Who Have Sex with Men in Los Angeles

This study evaluates associations between unrecognized HIV infection and demographic factors, internalized homonegativity, drug use, and sexual behaviors among HIV positive men who have sex with men (MSM). We analyzed data from 347 HIV positive participants from the Los Angeles site for NIDA’s Sexual Acquisition and Transmission of HIV-Cooperative Agreement Program. Participants were HIV positive MSM and MSM/W and predominantly African American (36.0%) or Latino (38.7%), and unemployed (82.8%). Results from a multivariate logistic regression suggest that, compared to HIV positive participants who correctly reported their HIV positive status, being African-American (OR: 9.81, CI: 1.2–77.9) or Latino (OR: 10.92, CI: 1.3–88.4) rather than White, MSM/W rather than MSM (OR: 3.24, CI: 1.09–9.62), and having higher homonegativity scores (OR: 1.22, CI: 1.02–1.4) is associated with unrecognized HIV infection, controlling for age, education, and homelessness. Findings provide some immediate evidence to help craft HIV prevention interventions.     

Prevalence and Correlates of Unprotected Anal Intercourse Among Hong Kong Men Who Have Sex with Men Traveling to Shenzhen, China

In China, the HIV prevalence among men who have sex with men (MSM) has been increasing sharply. A total of 195 Hong Kong MSM having had sex with men in Shenzhen, a mainland China city separated from Hong Kong by a border, were recruited from some randomly selected gay venues in Shenzhen. Participants were face-to-face and anonymously interviewed. The results showed that in the last six months, respectively 62.1, 84.6, and 31.3 % of the participants from Hong Kong had had sex with commercial sex partners (CSP), non-regular partners (NRP) and regular partners (RP) in Shenzhen. The prevalence of unprotected anal intercourse (UAI) with these three types of sex partners was respectively 29.8, 27.9, and 78.7 %. Factors associated with UAI with any MSM in Shenzhen in the last six months included perceived chances of contracting HIV, perceived non-availability of condoms, giving money/gifts to Shenzhen MSM sex partners, and perception that MSM partners in Shenzhen would not always insist on condom use (multivariate OR = 2.9–13.90, p < 0.05), whilst factors of inverse associations included university education, having had sex with NRP but not with CSP and RP in Shenzhen and self-efficacy of insisting on condom use (multivariate OR = 0.04–0.22, p < 0.05). In sum, the prevalence of having multiple types of male sex partners and UAI was high. This was especially true when anal sex with RP was involved. Cross-border HIV prevention is greatly warranted. It should ensure condom availability and modify perceptions toward UAI.     

A Protective Effect of Circumcision Among Receptive Male Sex Partners of Indian Men Who Have Sex with Men

The role of circumcision in the transmission of human immunodeficiency virus (HIV) among men who have sex with men (MSM) in resource restricted regions is poorly understood. This study explored the association of circumcision with HIV seroprevalence, in conjunction with other risk factors such as marriage and sex position, for a population of MSM in India. Participants (n = 387) were recruited from six drop-in centers in a large city in southern India. The overall HIV prevalence in this sample was high, at 18.6%. Bivariate and multivariable analyses revealed a concentration of risk among receptive only, married, and uncircumcised MSM, with HIV prevalence in this group reaching nearly 50%. The adjusted odds of HIV infection amongst circumcised men was less than one fifth that of uncircumcised men [adjusted odds ratio (AOR) 0.17; 95% CI 0.07–0.46; P < 0.001]. Within the group of receptive only MSM, infection was found to be lower among circumcised individuals (AOR, 0.30, 95% CI 0.12–0.76; P < 0.05) in the context of circumcised MSM engaging in more UAI, having a more recent same sex encounter and less lubricant use when compared to uncircumcised receptive men. To further explain these results, future studies should focus on epidemiologic analyses of risk, augmented by social and sexual network analyses of MSM mixing.     

HIV Disclosure and Sexual Transmission Behaviors among an Internet Sample of HIV-positive Men Who Have Sex with Men in Asia: Implications for Prevention with Positives

The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR?=?37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR?=?1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5?years ago (AOR?=?2.23, 95% CI: 1.05, 4.74), and not knowing one's viral load (AOR?=?2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men.     

东北某地男同性恋者艾滋病病毒/艾滋病的知识态度行为调查

目的　了解男同性恋者艾滋病相关知识、态度及危险行为状况 ,为行为干预提供线索。 方法　 采用横断面调查设计 ,对进出某酒吧的男同性恋者进行问卷调查。 结果　 文化程度普遍较高 ,但对艾滋病知识缺乏 ,知识的来源主要通过报纸、杂志和电视。安全套使用率低 ,每次性行为均使用安全套的比例为 1 4 4% ,不使用安全套的原因主要是自己或性伴侣不喜欢用或性行为时身边无安全套。随着艾滋病知识的增加 ,每次都用安全套的比例呈现上升趋势 ,从未使用安全套的比例则呈现明显下降的趋势。 1 1 7%做过艾滋病病毒 (HIV)检测 ,无人获得过HIV检测阳性结果。不做HIV检测的原因主要是自认为感染的可能性不大 ,认为自己是阴性或不想考虑阳性的事。首次性行为年龄中位数为 1 8岁 ;性伴侣数较多 ,平均为 1 0 3个。 40 5 %的调查对象在半年内有过女性性伴侣 ,96 6 %在半年内有过男性性伴侣 ,84 5 %半年内有无保护肛交史。 结论　 该市男同性恋者艾滋病相关知识缺乏 ,危险性行为普遍存在 ,安全套使用率低 ,艾滋病极有可能在此人群中流行 ,应尽快采取措施加强预防     

HIV-related Sexual Risk Taking Among HIV-negative Men Who Have Sex with Men in Zagreb,Croatia

Croatia has a low-level HIV epidemic and, as in a number of other Central and Southeastern European countries, sex between men accounts for most HIV infections. This study examines sexual behavior and the correlates of condom use in a snowball sample of 342 HIV non-infected men who have sex with men (MSM) in Zagreb. The median age of participants in the sample was 27 years. The majority of participants (81%) reported using condom at last anal sex with casual partner and 56% claimed to have used condoms consistently at anal sex with casual partners in the last 12 months. HIV risk self-assessment and number of sexual partners were significantly correlated with condom use at last anal sex with casual partner. Self-assessed HIV-risk and heterosexual activity were found associated with consistent condom use at anal sex with casual partners. To sustain a low-level HIV epidemic, targeted intervention among young MSM is needed in Croatia.     

Condom use in multi-partnered males: importance of HIV and hepatitis B status

The objective of the research was to determine the demographic, sexual and social risk factors associated with condom use in 7,089 multi-partnered men attending the Sydney Sexual Health Centre. A review of computerized medical records from 1991 to 1999 was carried out. Males with two or more partners in the last three months were divided into three condom use groups: consistent, sometimes and never. Men reporting sex with men (MSM) were more likely to use condoms than men having sex with only women (p=0.001). HIV positive men were more likely to use condoms consistently than those who were negative (p=0.001). In HIV negative non-hepatitis-B carriers, factors independently associated with inconsistent condom use included alcohol consumption, intravenous drug use (odds ratio (OR) 0.6 (95% confidence interval (CI) 0.47-0.77)) and being married (OR 0.2 (95% CI 0.21-0.31)). Factors associated with consistent condom use were MSM (OR 1.8 (95% CI 1.26-2.49)) and having three or more partners in the last 3 months (OR 2.4 (95% CI 2.023-2.83)). In the 508 hepatitis B carriers, consistent condom users were less likely to be married or intravenous drug users (OR 0.4 (95% CI 0.23-0.85)). In the 200 HIV antibody positive men, those with three or more partners were less likely to be consistent condom users than those with two (OR 0.3 (95% CI 0.11-0.82)). The conclusions are that a small number of HIV positive men report unsafe sex with multiple partners. Health promotion activities should be directed at this group.     

太原市男男性行为人群的认知态度对安全套使用行为和意向的影响

目的探讨太原市男男性行为人群（MSM）的认知态度对安全套使用行为和意向的影响。方法采用横断面研究设计,于2008年5至7月,对太原市城区范围内139名MSM的认知态度、安全套使用行为和意向进行问卷调查和分析。结果139名调查对象中,69.8%过去6个月有多个同性性伴,45.3%曾与异性发生性行为,21.6%有多个异性性伴;过去6个月与同性发生肛交性行为时坚持使用安全套的比例为50%,与异性发生性行为时该比例为31.7%;48.9%有坚持使用安全套意向。多因素Logistic回归分析结果显示,过去6个月与同性发生肛交性行为时坚持使用安全套有关的因素是,感知的安全套使用障碍（OR0.709,95%CI0.521-0.965）;与坚持使用安全套意向有关的因素是,感知的艾滋病易感性（OR2.259,95%CI1.303-3.918）和安全套使用自我效能（OR5.128,95%CI2.989-8.798）。结论调查对象多性伴和非保护性行为较为普遍,认知态度是安全套使用行为和意向的影响因素。     

Correlates of Bisexual Behaviors Among Men who have Sex with Men in El Salvador

Bisexual behaviors may increase transmission pathways of HIV and sexually transmitted infections (STIs) from a higher prevalence group to lower prevalence groups in El Salvador. In 2008, men who have sex with men (MSM) were recruited in San Salvador and San Miguel using respondent driven sampling. Participants were interviewed and tested for HIV and STIs. Sixteen seeds and 797 MSM participated; 34.9% in San Salvador and 58.8% in San Miguel reported bisexual behavior. Bisexual behavior was associated with drug use (adjusted odds ratio (AOR) = 2.57, 95% CI: 1.30–5.06) and insertive anal sex (AOR = 5.45, 95% CI: 3.01–9.87), and inversely associated with having a stable male partner (AOR = 0.47, 95% CI: 0.26–0.84) and disclosing MSM behavior to family (AOR = 0.41, 95% CI: 0.22–0.75). Bisexual behavior was associated with risk behaviors with male and female partners that may be associated with HIV and STI transmission. Bisexual men displayed a distinct identity calling for tailored interventions.     

Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India

OBJECTIVE: To obtain information on sex behaviour of a large sample of men who have sex with men (MSM) in India that would assist in planning HIV prevention. METHODS: Homosexual/bisexual behaviour of 6661 MSM at 62 urban-rural locations of various sizes in the Indian state of Andhra Pradesh was assessed through detailed interview. Multivariate analyses were performed to understand the associations with unprotected penetrative sex and barriers to condom use assessed. RESULTS: The average number of different male sex partners in past 4 weeks was six. In last three sex encounters with men, totalling 19 640, anal sex occurred in 16 769, at least once by 6121 (91.9%) MSM of which 3423 [55.9%; 95% confidence interval (CI), 51.7-60.1%] did not use condom at least once. A total of 2785 (41.8%) were currently married to women and 3354 (50.4%) had had vaginal/anal sex with women in the past 3 months, of which 2818 (84%; 95% CI, 81.1-86.9%) did not use a condom. Furthermore, 1585 (25.9%; 95% CI, 22.7-29.1%) had anal sex without a condom with men and also vaginal/anal sex without a condom with women. This was prevalent across urban-rural locations and its strongest association was with currently married MSM (odds ratio 15.1; 95% CI, 12.5-18.2). The predominant reason for not using a condom with women was 'do not use with regular partner' (68.4%). CONCLUSION: This high rate of unprotected penetrative sex by MSM with both men and women suggests that HIV prevention efforts in India should include a focus on MSM as well as their wives across many urban-rural locations and not only in large cities.     

Predictors of unprotected sex among men who have sex with men in Beijing, China

To estimate the prevalence of HIV and syphilis and to assess the predictors of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in Beijing, a community-based survey recruited MSM in 2005 through internet advertisement, community outreach, and peer referral. Demographic, sexual, and HIV risk behavioral information were collected. Serospecimens were tested for HIV and syphilis infections. Of the 526 participants, 3.2% were HIV-positive, 11.2% syphilis-positive, 50% and 43.3% had UAI with regular and casual sex partners, respectively. Participants practicing UAI with regular male partners were independently associated with lower monthly income (adjusted odds ratio-AOR, 1.7; 95% CI, 1.0-3.0) and encountering male sex partners at bathhouses, public washrooms, and parks (AOR, 2.2; 95% CI, 1.0-4.9). Participants practicing UAI with casual male partners were associated with encountering male sex partners at bathhouses, publics washrooms, and park (AOR, 3.0; 95% CI, 1.8-5.2) and more male sex partners having receptive anal intercourse (AOR, 1.8; 95% CI, 1.1-2.9), and was inversely associated with receiving money for sex with men (AOR, 0.3; 95% CI, 0.2-0.7). Professional male sex workers were less likely to practice UAI in Beijing, suggesting the benefits of educational outreach to date. Further education, condom promotion, and prevention of sexually transmitted infections should be intensified urgently to combat the rising HIV epidemic among MSM in Beijing.     

Factors Associated with Unprotected Anal Intercourse Among Men Who Have Sex with Men: Results from a Respondent Driven Sampling Survey in Nanjing, China, 2008

Unprotected anal intercourse (UAI) is a well-documented risk factor for acquiring HIV, but not well-studied in China. We studied demographic and behavioral correlates for UAI among men who have sex with men (MSM) in a respondent-driven-sampling (RDS) survey in Nanjing, China. Four hundred and thirty MSM (including ten seeds) participated in this study, rendering an adjusted rate of UAI as 62.3 % (95 % CI 56.4–68.4 %). Adjusted HIV and syphilis prevalence rates were 6.6 % (95 % CI 3.0–10.4) and 12.6 % (95 % CI 8.1–18.3), respectively. HIV- and syphilis-positive cases were more likely to have engaged in UAI. Being unwilling to use condoms, meeting partners in non-conventional venues, having multiple male sex-partners in the past 6 months, having sex with regular and casual male partners in the past 6 months, and consumption of alcohol before sex were all positively associated with UAI. Based on the observed high prevalence of UAI among MSM in Nanjing, we can conclude that implementation of strategies to motivate MSM with high-risk behaviors to use condoms is urgently required in Nanjing.