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Risk attitudes, risky sexual behaviours and willingness to test negative for syphilis using lottery-based financial incentives among Chinese men who have sex with men
  1. Jason J Ong1,2,
  2. Chang Chang Li3,4,
  3. HongYun Fu5,6,
  4. Juan Nie3,4,
  5. Weiming Tang3,4,
  6. WeiBin Chang3,4,
  7. M Kumi Smith7,
  8. Michael Marks1,
  9. Bin Yang3,4,
  10. Cheng Wang3,4,
  11. Joseph Tucker1,5
  1. 1 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Central Clinical School, Monash University, Clayton, Victoria, Australia
  3. 3 Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China
  4. 4 Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
  5. 5 University of North Carolina Project China, Guangzhou, China
  6. 6 Community Health and Research Division, Eastern Virginia Medical School, Norfolk, Virginia, USA
  7. 7 Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Cheng Wang, Dermatology Hospital of Southern Medical University, Guangzhou 510095, China; wangcheng090705{at}


Background Individuals with risk-loving attitudes may be more likely to participate in high-risk sex and gambling. We investigated whether a lottery-based financial incentive to have a negative syphilis test may attract Chinese men who have sex with men (MSM) who practised risky sexual behaviours.

Methods In July 2018, a national online cross-sectional survey was conducted in China. We collected information on willingness to participate in a lottery-based financial incentive where men were eligible if they tested negative for syphilis, and the minimum prize that would attract them to participate. We used a validated risk attitude scale which asked about the willingness to take risks in six domains, ranging from 0 (avoids taking risk) to 10 (fully prepared to take risks). To avoid multicollinearity, we used principal components analysis to create a ‘risk attitude index’. Bivariable and multivariable logistic regression explored factors associated with willingness to test negative for syphilis.

Results 699 MSM enrolled with a median age of 26 years (IQR: 23–30). 70% self-identified as gay and 52% reported ever testing for syphilis. 64% stated they were likely or very likely to test for syphilis linked with a lottery-based incentive. The median desired amount for the lottery had an expected value of ¥10 (US$1.50, IQR: ¥5–¥30). Men who had greater odds of willingness to participate in the lottery-based incentive were those scoring highest on the risk attitude index (adjusted OR (AOR) 2.6, 95% CI 1.5 to 4.3), those reporting more than one sexual partner in the last 3 months (AOR 1.7, 95% CI 1.2 to 2.4), those who had not used condoms during their last sex (AOR 1.5, 95% CI 1.0 to 2.2) and those who ever had group sex (AOR 1.5, 95% CI 1.0 to 2.2).

Conclusion Chinese MSM with higher risk attitudes and who reported riskier sexual behaviours indicated greater interest in the concept of a lottery-based incentive for syphilis testing. A lottery-based incentive may be a promising strategy for promoting condom use among risk-loving men.

  • syphilis
  • testing
  • attitudes
  • gay men
  • China

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  • Handling editor Jane S Hocking

  • JJO and CCL contributed equally.

  • Contributors CW, WC, CCL, WT, JT and JJO conceived and planned the study. CW, WC and CCL coordinated the study, participant recruitment and management. JJO and CW analysed the data and drafted the manuscript, and all authors revised and approved the final manuscript.

  • Funding This study was funded by the Dermatology Hospital of Southern Medical University.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the Dermatology Hospital of Southern Medical University (GDDHLS-20181206).

  • Provenance and peer review Not commissioned; externally peer reviewed.