A cross-sectional study based on a large-scale survey was conducted among MSM between July and December 2023.

MSM were eligible to participate if they met certain criteria, which include being (1) 16 years or older, (2) reported having sex with men in the past year, (3) were HIV-negative or had an unknown HIV status, (4) received HIV testing as a direct result of mobile social media promotion or volunteer-driven recruitment, and (5) resided in Zhejiang Province, China.

Sunshine Coast Public Welfare is a social service agency that employs 13 full-time and 22 part-time social workers, with over 400 registered volunteers. The organization established a digital HIV prevention service using location-based services. MSM in Zhejiang Province are invited to visit the official “Sunshine Test” account on WeChat, a popular Chinese communication platform, to request free HIV testing and prevention counseling. MSM can choose between mailed self-testing kits or visiting offline services for HIV testing. Full-time and part-time social workers are responsible for regularly recruiting a specified number of MSM for HIV testing. Meanwhile, registered volunteers assist in promoting HIV testing within the MSM community periodically.

All individuals who engaged with Sunshine Test were required to complete a routine surveillance questionnaire consisting of 20 questions. These questions covered demographic information such as age, marital status, and education level, as well as sexual behavior including sexual roles (receptive, insertive, or both), number of sexual partners, use of rush poppers, sexual history, awareness of pre-exposure prophylaxis (PrEP) and PEP (postexposure prophylaxis), and HIV testing history.

Recruitment through direct engagement by social workers or registered volunteers was classified as “volunteer-driven recruitment.” Conversely, if MSM were recruited after encountering HIV prevention information posted by the community organization on internet platforms (such as dating apps, communication groups, or websites) and subsequently applied for testing, this was categorized as “mobile social media promotion recruitment.” If MSM had undergone an HIV test at the organization of their own volition, without being prompted by volunteers or mobile social media promotion, their case was classified as a “regular test.” During the study, the participating MSM underwent repeated HIV testing on more than 2 occasions, but only the first record was included in the analysis. Details of the Sunshine Coast Public Welfare Program have been described in previous literature [10].

Descriptive analyses were performed, with categorical variables presented as frequencies and proportions and continuous variables presented as median with IQR or mean with SD. The chi-square test (Χ²) was used to assess significant differences in demographic characteristics between MSM recruited through mobile social media promotion and those recruited through volunteer-driven recruitment. Factors associated with differences in the sociodemographic characteristics of mobile social media promotion recruitment were included in multivariate logistic regression models, and adjusted odds ratios (aORs) with 95% CIs were calculated. Statistical significance was set at P<.05, with β=.1. All statistical analyses were conducted using SPSS (version 19.0; IBM Corp).

This study was approved by the Zhejiang Provincial Centre for Disease Control and Prevention (approval number 2022-011-01). Written informed consent was obtained from all participants before survey completion, and participants had the ability to drop out anytime during the survey. All data were anonymous; participants received free HIV testing, health counseling, and no compensation; and all study procedures were conducted in accordance with approved guidelines and regulations.

This study compared the sociodemographic and behavioral characteristics of MSM who were recruited through 2 different recruitment strategies by community organizations to engage in HIV testing in Zhejiang Province, China. The strategies examined were a mobile social media promotion strategy and a volunteer-driven recruitment strategy. The findings indicated that 66% (3035/4600) of MSM were recruited through mobile social media promotion, while both strategies together reached 18.8% (865/4600) of MSM who had never been tested for HIV. Consistent with previous studies [18], community organizations proved effective in increasing HIV testing rates among MSM, particularly those who had not been tested before. The implementation of both strategies successfully expanded intervention coverage and recruited MSM who had not been previously tested for HIV. Furthermore, ongoing support for community organizations is recommended to facilitate the implementation of MSM prevention and control initiatives.

Our findings revealed a higher proportion of individuals undergoing their first HIV test (592/3035, 19.5% vs 273/1565, 17.4%) and a higher prevalence of HIV-positive results (52/3035, 1.7% vs 14/1565, 0.9%) among those engaged via mobile social media promotions compared to those recruited through volunteer-driven initiatives. These observations are consistent with previous studies and empirical data. A meta-analysis demonstrated a 50% increase in HIV testing uptake following social media interventions [19], and another study showed a 22% increase in testing through mobile platforms [20], particularly among MSM engaging in high-risk behaviors. In these populations, the HIV-positive rate was 3.5% [21]. These findings suggest that mobile social media promotion may be an effective approach for recruiting MSM, improving HIV-testing coverage, and identifying individuals infected with HIV, particularly those who have not previously undergone HIV testing. As the proportion of MSM who use the internet and dating software continues to grow, it may be beneficial to expand the use of mobile social media promotion strategies to enhance HIV testing among MSM and facilitate the identification of more individuals infected with HIV. This could be a crucial step toward achieving the goal of diagnosing 95% of individuals infected with HIV by 2030.

Similar to previous studies [22,23], our findings indicate that MSM recruited through mobile social media were more likely to use mail-based HIV self-testing kits. Mobile promotion strategies can facilitate the recruitment of MSM who have not accessed HIV testing services by providing convenient mail-in self-testing kits, thus increasing overall testing and identifying more individuals infected with HIV. Another study demonstrated that HIV self-testing services have the potential to enhance test uptake and reduce undiagnosed infections [24]. It would be beneficial to provide targeted outreach to MSM, such as offering HIV self-testing [25]. The utilization of social media platforms may prove effective in enhancing HIV self-testing rates among MSM aged ≤35 years [26]. Nevertheless, research has indicated that mobile social media may not necessarily increase the rate of HIV testing [27]. This may be attributed to the fact that the testing rate may not be enhanced by repeated HIV publicity and intervention in large cities but rather in areas where HIV testing is not easily accessible and where supportive gay social networks and health professionals are scarce. Therefore, priority should be given to implementing mobile social media promotion in areas lacking LGBTQ+ organizations or HIV health services. This approach can facilitate MSM recruitment, thereby increasing intervention coverage and improving HIV testing. Concurrently, it is also recommended to continue increasing publicity about HIV self-testing and to provide convenient self-testing services.

Consistent with other studies [28,29], we found that MSM recruited via mobile social media promotion were more aware of PrEP and PEP. Dating apps and social media have been identified as underutilized tools for increasing PrEP awareness, uptake, and knowledge among MSM [28,29]. PrEP and PEP represent effective prevention tools for individuals at high risk of HIV exposure, effectively reducing HIV infection and transmission [30]. Since 2021, PrEP and PEP have been widely used in China [31], with much of the advertising and promotion happening mobile. This has substantially increased awareness among MSM using the Internet. This study demonstrated that most MSM initially learned about PrEP through mobile sources [32]. Efforts should be made to further promote PrEP and PEP through mobile platforms while also disseminating preventive information through offline volunteer-driven strategies.

Our findings also revealed that MSM recruited mobile were more likely to report using rush poppers, a recreational drug that has gained considerable popularity among MSM [33], and their rate of use has continued to increase in China [34]. The use of rush poppers has been linked to abnormal arousal and pleasure, and prolonged sexual activity; these factors may increase the likelihood of engaging in unprotected sexual activity with consequent adverse outcomes such as HIV infection [30] and transmission [35]. Furthermore, a greater proportion of MSM seeking sexual activity through social media have reported recreational drug use compared to those using traditional venues [21]. Therefore, it is recommended that internet-based HIV interventions include information on the risks associated with rush poppers and their link to HIV transmission to raise awareness and reduce high-risk behaviors.

The study also revealed that MSM recruited mobile had more sexual partners and a higher prevalence of STIs compared to those recruited through volunteer-driven strategies. A meta-analysis conducted in China revealed that MSM who engage in substance abuse are more likely to seek sexual partners through the internet or social media and engage in unprotected anal intercourse [36]. One potential explanation for this is that the volunteer-driven strategy for MSM tends to focus on offline recruitment in venues such as bars, parks, and bathhouses, where social circles are relatively limited. The advent of the Internet has provided MSM with more opportunities to search for sexual partners. Mobile social media have demonstrated efficacy as a tool for increasing PrEP use [29] and HIV-testing uptake [32]. While PrEP reduces the risk of HIV infection, it does not prevent STIs [37] and may even increase the risk due to reduced condom use and increased high-risk sexual behaviors [38]. Therefore, alongside PrEP promotion, other targeted interventions promoting condom use and awareness of STI risks should be integrated into internet-based HIV prevention efforts.

First, the participants recruited by the community organization were primarily younger MSM who use the internet, meaning older MSM (particularly those over 50) were underrepresented. Future research should explore recruitment strategies targeting older MSM who do not engage mobile. Second, the costs associated with the human and financial resources invested in these recruitment strategies were not assessed. Further research on the cost-effectiveness of these strategies is necessary. Finally, the study relied on routine surveillance questionnaires, which may not have captured all relevant factors influencing the effectiveness of the 2 investigated recruitment strategies.

Community organizations effectively use mobile social media promotion and volunteer-driven strategies to recruit MSM, playing an important role in improving HIV testing and identifying undiagnosed individuals infected with HIV. There are notable differences in recruitment outcomes between the 2 strategies, with mobile social media promotion leading to a higher proportion of first-time HIV testing and HIV-positive individual identification. In areas where LGBTQ+ organizations or HIV health services are scarce, mobile social media promotion should be prioritized to increase MSM recruitment and expand the coverage of HIV interventions.