The effect of sexual orientation, gender identity, and marital intention on HIV prevention outcomes among MSM students in Southeast China.

Yet studies fail to consider how a lack of concordance among sexual orientation, gender identity, and intent to marry or date a woman hinders the improvement of HIV prevention outcomes. We sought to explore the overlap of the three variables and examine associations between each aspect and HIV prevention outcomes among college students MSM. A cross-sectional study was conducted in six cities in Zhejiang province in 2022. All subjects were recruited by four community-based organizations, reporting sexual orientation, HIV knowledge, HIV self-testing, Post-exposure Prophylaxis(PEP), and Pre-exposure Prophylaxis (PrEP). Among 671 participants, 43.8%(294/671) reported a gay identity along with a male identity and no intent to marry or date a woman. The structural equation model showed that the effect of sexual orientation on the intent to marry or date a woman is positive (β = 0.035, p< 0.001); After controlling 4 confounders, sexual orientation had a negative effect on HIV self-testing (β=-0.129, p < 0.01), HIV knowledge (β=-0.099, p < 0.01); There was partial mediating effect of marriage intention on the influence of sexual orientation on HIV knowledge (β = 0.021, 95CI%:0.001-0.046), have taken PEP (β = 0.019, 95CI%:0.002 ~ 0.040) and ever heard of PrEP (β=-0.023, 95CI%:-0.048-0.003). For college students MSM, sexual orientation may affect HIV prevention outcomes both directly and indirectly through attitudes toward marriage.