Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study

Abstract

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, 7 focus group discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, non-disclosure to families, misconceptions of domestically produced antiretroviral drugs and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.

Barriers and Facilitators of Linkage to and Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study

“…31 The knowledge about the intervening factors has remained limited. 12,32 Consistent with other observations, 26,33,34 HIV-positive Chinese MSM reported barriers to care that may be remediable with clinic staff training (addressing discriminatory attitudes, coaching staff on follow-through, ensuring privacy and disclosure confidentiality), structural adjustments (improving accessibility of HIV care facilities), and improved information sharing with communities and clients (to address a lack of understanding what services are offered, and negative patient attitudes towards HIV care and ART). Similarly, declared facilitators of HIV care suggest positive program options that can be preserved, initiated, or expanded, including government support to compensate all HIV care costs, provision of sustained and comprehensive HIV care, and peer support/referral/counseling.…”

A peer-led, community-based rapid HIV testing intervention among untested men who have sex with men in China: an operational model for expansion of HIV testing and linkage to care

“…Receiving social support at the early stage following diagnosis can reduce individuals’ stress and anxiety and better prepare them for entry into care. Within the Chinese context, peer counsellors might be the only immediate support MSM are able to access and willing to accept, particularly if they are reluctant to disclose HIV and MSM status to family, friends or health providers for fear of rejection and discrimination 27. A lesson from our pilot project is that support needs to be continuously available to newly diagnosed MSM until they are fully engaged in care.…”

Estimation of the HIV Incidence and of the Number of People Living With HIV/AIDS in Brazil, 2012

“…Although the increasing coverage of HIV testing in Brazil gives some indication that people are generally open to routine HIV screening, as HIV testing in antenatal care for pregnant women, known benefits of early treatment are outweighed by a perceived burden related to stigma and fear of being positive [52][53][54]. The Brazilian Behavioral Surveillance Survey, 2012 found that more than 60% of those with self-evaluation of high HIV infection risk had never tested for HIV.…”