Objective  To understand the HIV infection status and sexual behavior characteristics in men who have sex with men (MSM) in Hubei province, and provide reference for the further improvement of local AIDS prevention and control measures in MSM.

  Methods  Sentinel sites were set in areas with high numbers of MSM and HIV infection cases in Hubei from 2016 to 2022. A continuous cross-sectional survey was conducted, and anonymous questionnaire survey were conducted and blood samples were taken to collect socio-demographic, sexual and serological information of the MSM. Mantel-Haenszel linear trend analysis was used to test the linear trend of each index over the years, and Spearman's correlation coefficient was used to reflect the strength of the linear trend. Logistic regression model was used to analyze the factors related to HIV infection in the MSM.

  Results  During 2016−2022, the positive rate of HIV antibody in the MSM ranged from 2.22% to 4.48%. Although there was a linear trend over the years, the linear correlation was weak (r_s=−0.019). From 2016 to 2022, the awareness rate of HIV/AIDS related knowledge in the MSM ranged from 95.22% to 95.82%, and the prevalence of condom use in the MSM in last anal sex ranged from 82.19% to 81.66%, both remained stable basically from 2016 to 2022. In the past 6 months, the proportion of MSM with condom use in anal sex increased from 52.67% to 65.22%, and the proportion of MSM receiving HIV test increased from 46.18% to 65.74%, both showed a linear upward trend from 2016 to 2022 (all P<0.05). The proportion of MSM with anal sexual behaviors in the past 6 months decreased from 96.14% to 92.95%, the proportion of MSM with heterosexual sexual behavior in the past 6 months decreased from 25.62% to 23.68%, and the proportion of MSM who received intervention services in the last year decreased from 99.04% to 92.92%. All showed a linear downward trend from 2016 to 2022 (all P<0.05). Multivariate logistic regression analysis showed that age ≥60 years, unmarried, divorced or widowed, being from other provinces or foreign countries, local residence for more than 2 years, education level of primary school or below, non-consistent condom use in anal sex in the past 6 months, receiving no intervention services in the last year, suffering from syphilis and infection with hepatitis C virus were the risk factors for HIV infection in the MSM (all P<0.05).

  Conclusion  The HIV positive rate in MSM in Hubei fluctuated at a high level from 2016 to 2022. The proportion of MSM with condom use and HIV testing increased significantly, but the proportion of MSM receiving intervention services decreased. The existing factors related to HIV infection varied. It is necessary to strengthen targeted and appropriate intervention services and health education in MSM, especially in those with low education level, older age and without consistent condom use to further reduce the HIV transmission risk and infection level in this population.