A Comparison of Mobile Social Media Promotion and Volunteer-Driven Strategies for Community Organizations Recruiting Men Who Have Sex with Men for HIV Testing in Zhejiang Province, China: Cross-Sectional Study Based on a Large-Scale Survey

Background: China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testinguptake, the relative effectivenessofmobilesocial mediapromotioncomparedwithvolunteer-drivenrecruitmentremains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing. Objective: This study aimed to comparethe differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing. Methods: A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion. Results: The study included 4600 MSM, of whom 3035 (66%) were recruited through the mobile social media strategy. Overall, 1.4% (66/4600) of participants tested positivefor HIV, and 18.8% (865/4600) underwent HIV testing for thefirst time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95% CI 1.19-1.71), having awarenessof postexposureprophylaxis(PEP; aOR 1.49, 95% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95% CI 1.09-1.52). Conclusions:Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion offirst-timetesters and ahigher rate ofHIV positivity. We recommend prioritizing mobilesocial media strategies in regions with limited LGBTQ+organizations or HIV health services to increase HIV testing coverage and interventions among MSM.