A HIV status-stratified analysis of Mpox risk factors among MSM in Mainland China over two years (2023-2024).

BACKGROUND

The global Mpox epidemic has disproportionately affected men who have sex with men (MSM). This study describes the factors associated with Mpox infection among Chinese MSM and examines whether these factors differ between HIV-positive MSM and HIV-negative MSM.

METHODS

We conducted online cross-sectional surveys in August-September 2023 and 2024, recruiting 15,848 MSM from 30 provinces in China. Weighted logistic regression models were then used to estimate the self-reported Mpox infection, stratified by HIV status.

RESULTS

Among 170 reported Mpox cases, 47.1% were HIV-positive. In the overall sample, higher education and income were associated with lower risk, while international travel was associated with higher risk. When stratified by HIV status, the associated factors differed. For HIV-positive MSM, having sexual partners with skin rash symptoms and STD infection were significantly associated with Mpox infection. For HIV-negative MSM, group sex and lower attention to Mpox information were significantly associated with infection.

CONCLUSION

HIV status defines divergent Mpox risk profiles among Chinese MSM. An effective response requires differentiated strategies: integration of Mpox prevention into HIV care cascade systems for people living with HIV, and the implementation of behavior-focused interventions for HIV-negative MSM. Longitudinal studies grounded in behavioral and network theories are now urgently needed to establish causal pathways, elucidate the mechanisms driving these divergent risk architectures, and evaluate the long-term effectiveness of stratified intervention approaches.