Sexual Risk Behavior and Satisfaction Among Men Who Have Sex With Men Living With Detectable HIV Viral Loads: A Nationwide Online Survey in China

Little is known about sexual behavior and satisfaction among men who have sex with men (MSM) with detectable HIV viral loads (VL) in China. This study aims to investigate sexual risk behavior and sexual satisfaction among MSM living with HIV in China, as well as potential predictors. This cross-sectional study was conducted in February 2021 using an anonymous online survey based on WeChat. Data were collected on sociodemographics, sexual behavior, HIV clinical information, sexual satisfaction and mental health. Descriptive statistics, logistic regression and multivariable logistic regression were performed. MSM with detectable HIV VL (VL+) or VL not sure were more likely to report inconsistent condom use, even with HIV-negative/unknown-status regular male partners. Having an HIV-positive regular partner and recreational drug use were positively associated with inconsistent condom use during anal sex among MSM with undetectable VL (VL-). Alcohol use before or during sexual activities was positively associated with inconsistent condom use during anal sex among VL+ or VL not sure MSM. A total of 58.3% of participants reported being sexually satisfied. MSM living with HIV who were currently employed, had experienced anal sex in the prior 6 months, had VL- HIV status, or had more frequent ejaculation during sex/masturbation were more likely to report sexual satisfaction. The development of targeted education and interventions to minimize sexual risk behavior among MSM living with HIV is in dire need. Treating sexual dysfunction and developing a reasonable antiretroviral therapy regimen to achieve viral suppression can help promote sexual satisfaction in MSM living with HIV.