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Tenofovir to Prevent HIV Infection in Western China: Pragmatic Randomized Controlled Trial
In 2023, men who have sex with men (MSM), bisexual individuals, sex workers, and people who inject drugs remained the highest-risk groups for HIV, with sexual transmission accounting for more than 95% of new infections in China [1,4]. MSM continue to represent the group with the highest HIV incidence rate globally, with infection rates rising nearly 15-fold from 1.5% in 2006 to 25.6% in 2022 [5,6].
JMIR Public Health Surveill 2025;11:e71494
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Men who have sex with men (MSM) are the most vulnerable population for HIV globally, accounting for 44% of new HIV cases in the Asia-Pacific region [1]. Malaysia, an upper middle-income country in this region, is experiencing one of the fastest growing HIV epidemics in MSM [2,3], characterized by a shift from needle sharing to sexual transmission [4].
JMIR Hum Factors 2025;12:e70034
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In addition, younger MSM are more likely to engage in casual relationships, often facilitated by dating apps, leading to multiple sexual partners and further increasing their likelihood of HIV exposure [21,22].
HIV prevention efforts, such as pre-exposure prophylaxis (Pr EP), often focus predominantly on young MSM, while there is limited literature on the subject regarding older MSM [15,23]. Pr EP has been shown to be effective in preventing HIV among MSM of all ages.
JMIR Public Health Surveill 2025;11:e58405
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The sharp rise in the number of new HIV infections among men who have sex with men (MSM) has continued in Asia, and sexual activity between men remains stigmatized and frequently hidden. HIV prevalence among MSM was 5% or higher in 10 of the 24 countries that reported these statistics to the Joint United Nations Programme on HIV/AIDS in 2019 [2]. Approximately 30% of all new infections in Asia are in MSM, and HIV incidence is high among young (15-24 years old) MSM [2].
JMIR Res Protoc 2025;14:e65351
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The outbreak predominantly affects men who have sex with men (MSM), who account for 85.8% of cases with known sexual behavior data [4,5]. China, with the world’s largest MSM population—estimated at 8.3 million, nearly 1.8 times the size of the United States’ MSM population—faces unique public health challenges in controlling mpox transmission [6].
JMIR Public Health Surveill 2025;11:e68400
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The community organization is composed of MSM volunteers, which allows for forming trusting relationships and facilitates contact with the MSM population, thus bringing attention to this previously hidden demographic [9,10]. A previous study revealed that 567 MSM community-based organizations in China participated in initiatives funded by the AIDS fund for nongovernmental organizations, facilitating HIV testing for over 250,000 people by 2022 [11].
J Med Internet Res 2025;27:e66702
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In 2019, pre-exposure prophylaxis (Pr EP) was established as safe and effective in preventing HIV among adolescent-aged men who have sex with men (MSM), and the US Food and Drug Administration approved Pr EP for individuals weighing at least 77 pounds (~34.9 kg), thereby making it available to adolescents [10,11]. Nevertheless, prescribing Pr EP to adolescents remains under ideal levels [12].
JMIR Res Protoc 2025;14:e63114
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However, few studies to date have examined how structural determinants may have shaped mpox testing in a large, national sample of MSM [9,10].
Beyond structural factors, engagement in mpox screening and testing services may be driven by individual factors, particularly risk perception and behavioral indication for mpox tests [11]. For example, GBMSM who report regular condom use have been found to have lower engagement in testing for HIV [12] and bacterial STIs [13].
JMIR Public Health Surveill 2025;11:e57399
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A previous meta-analysis showed that using mobile health technology could increase the linkage to care among MSM using HIV self-testing [26].
Zhejiang province is economically developed, with an active digital economy. Approximately 66,000 HIV tests were performed among MSM in 2023, accounting for 10% of the national proportion [2], and over 70% of HIV testing among MSM in Zhejiang province relied on the internet.
JMIR Public Health Surveill 2025;11:e66139
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Card et al [12] used GT and Canadian census data to estimate the local PSE of MSM in urban and rural locations throughout Canada. Card et al [12] related search terms presumed to be representative of MSM (“gay porn”) to that presumed to be representative of the general (male) population (“porn”). By relating these 2 sets of values, Card et al [12] estimated the relative size of MSM in these Canadian towns. To date, no other published PSE exists using this method.
JMIR Public Health Surveill 2025;11:e58630
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