Objective  To examine the prevalence and risk factors of human immunodeficiency virus (HIV) infection among the men who have sex with men (MSM) ever having homosexual behaviors at bathhouses in Urumqi city of Xinjiang Uygur Autonomous Region for developing effective interventions on HIV transmission in the MSM.

  Methods  Voluntary HIV counseling and testing service settings were established at selected bathhouses with MSM attendees in Urumqi city from 2016 through 2018 and on-site voluntary HIV counseling and testing, questionnaire interview and follow up services were carried out among 2 195 MSM during the 3 year period.

  Results  Among all the MSM surveyed, totally 188 serum HIV antibody positives were detected, with an overall positive detection rate of 8.56%; the annual positive detection rate were 12.96% (77/594), 9.38%, (75/800) and 4.49% (36/801) for the three years, with a significant downward trend (χ² = 32.01, P < 0.001). Significant decreasing trend was observed in the reported annual proportion of having homosexual behavior during previous 6 months (χ² = 6.72, P = 0.01), inconsistent condom use (χ² = 252.70, P < 0.001), having multiple sexual partners (χ² = 15.25, P < 0.001), and drug use (χ² = 5.77, P = 0.016); but the reported annual proportion of ever receiving peer education during previous one year (χ² = 376.75, P < 0.001) and annual rate of awareness on relevant knowledge (χ² = 115.14, P < 0.001) increased significantly. The results of logistic regression analysis revealed following risk factors for HIV infection among the MSM: suffering from sexually transmitted diseases during previous one year (adjusted odds ratio aOR = 2.93, 95% confidence interval 95% CI: 1.85 – 4.63), inconsistent condom uses (aOR = 2.27, 95% CI: 1.62 – 3.17), having homosexual behavior with multiple partners (aOR = 1.80, 95% CI: 1.26 – 2.56), with multiple sexual partners (aOR = 1.62, 95% CI: 1.16 – 2.26), residing in local region less than one year (aOR = 1.592, 95% CI : 1.076 – 2.365), and at the age of under 35 years (aOR = 1.51, 95% CI: 1.10 – 2.08).

  Conclusion  The prevalence of high-risk behaviors is relatively high among MSM having sexual activity at bathhouses in Urumqi city and onsite comprehensive intervention programs at the bathhouses may reduce high-risk behaviors and HIV infection among the MSM.