Factors Associated with HIV Infection in MSM Visiting Bathhouses: A Structural Equation Model Analysis of a Cross-Sectional Survey in Eastern China.

Abstract

Objectives: This study aimed to explore the factors associated with Human Immunodeficiency Virus (HIV) infection among men who have sex with men (MSM) during bathing activities to provide a basis for developing comprehensive interventions to curb the incidence of HIV infections in this population.

Materials and methods: A cross-sectional survey was performed. MSM who engaged in oral or anal sex with male partners in the past 6 months were recruited as participants. The participants were tested for HIV antibodies, and information regarding their sexual behaviors was collected through one-on-one surveys. Using exploratory factor analysis, we constructed a structural equation model for fitting, which was later adjusted to analyze the relationships and degrees of influence among various variables.

Results: The study included 465 participants (mean age: 40.62 ± 12.15 years) in this study. Of them,68.4% were married, and 10.3% tested positive for HIV antibodies. While 6.2% reported engaging in group sex, 76.6% had anal sex with casual male partners in the past 6 months. Only 31.2% of participants consistently used condoms during homosexual intercourse. The structural equation model indicated that while the sexual behavioral characteristics of bathhouse-active MSM had a direct positive association with HIV infection (path coefficient: 0.32), the frequency of visits to bathhouses had a direct negative association (path coefficient:-0.17). Demographic characteristics and bathhouse visit frequencies had direct positive associations with sexual behavior characteristics (path coefficients of 0.24 and 0.25, respectively).

Discussion: This study found that high-risk sexual behaviors, such as group sex, anal sex with casual partners, and inconsistent condom use, were associated with HIV infection among bathhouse-active MSM. While frequent bathhouse visits showed a negative association with infection, demographic characteristics were associated with HIV risk indirectly through sexual behaviors. Targeted interventions, particularly for first-time visitors, are needed to promote safe sexual practices in bathhouse settings.

Conclusion: Bathhouse-active MSM engage in unsafe behaviors, such as group sex, anal sex with casual male partners, and inconsistent condom use during sexual encounters, all of which are risk factors for HIV infection. Therefore, there is a need to strengthen health promotion and education in this population, focusing on timely interventions for first-time bathhouse patrons to encourage safe sexual behaviors and reduce the risk of HIV transmission.