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RDS is based on a long-chain referral recruitment strategy, which is thought to be advantageous in reaching the most hidden segments of already-hidden populations 16 and has been adopted by public health researchers worldwide for sampling injecting drug users (IDUs), MSM and commercial sex workers successfully in China 17, 18 and other areas of the world. 15 To overcome the difficulties of monitoring sexual risk and HIV prevalence in this population and to improve the representation of MSM samples, respondent-driven sampling (RDS) was used to access and recruit participants in recent studies. In addition, convenience surveys may be effected easily by bias and the final composition of the sample is heavily dependent upon the choice of seeds and short recruitment chains within their own social network. Convenience sampling tends to recruit the most visible segments of a hidden population and may miss some subgroups that are not easily accessed, thus falling short of achieving a diverse sample. 13, 14 However, because of the stigmatisation of homosexuality, MSM are hard to reach in China, thus, the participants of this research were recruited by using convenience sampling. Previous surveys have reported low HIV prevalence among MSM in China and age and frequency of sex were positively associated with the risk of HIV infection. In order to effectively guide and evaluate prevention programmes, in-depth data on MSM are needed. 10, 11 Among all the cities of Zhejiang province, Hangzhou, Ningbo and Wenzhou are the top three HIV epicentres prevalence of HIV infection in these three cities were 8.71%, 8.97% and 9.23% in 2011, respectively, and became 12.3%, 10.29% and 7.23%, in 2013. Between 20, data from sentinel surveillance described a steady increase in HIV seroprevalence from 4.4% to 8.6%. Within this province, epidemics of HIV in MSM continue to expand. Zhejiang, a coastal province located in the South-East with a total population of 54.49 million, is one of the most densely populated and economically vibrant provinces in China. 8 Understanding the risk behaviours and sociodemographic characteristics of MSM helps in guiding evidence-based prevention efforts.
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6 With the same transferring routes, syphilis is also a biological factor associated with HIV infection 7 and a majority of men who have sex with men (MSM) with syphilis have been reported to be HIV-positive. 3 Male homosexuality has received increased attention in recent years, because HIV transmission through homosexual behaviours increased from 0.3% before 2005 to more than 13.7% in 2011, 4, 5 and 25.8% of new-found HIV infectors were infected through homosexuals in 2014. 1 In China, an estimated two to five per cent of all male adults are homosexual/bisexual, 2 and the main transmission route of HIV in China has shifted from injection drug use to sexual transmission. Globally, 3–25% of all HIV/AIDS infections are transmitted via male homosexual behaviours, and this prevalence is much higher compared with regional adult HIV prevalence.
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HIV transmission through homosexual behaviours is drawing more and more attention in recent years.