Coercion and HIV self-testing in Chinese men who have sex with men: implementation data from a cross-sectional survey

Ong, Jason J.; Li, Haochu; Wu, Dan; Fu, Hongyun; Liu, Ewen; Ma, Wei; Kang, Demin; Liao, Meizhen; Marley, Gifty; Wei, Chongyi; Tang, Weiming; Pan, Stephen W.; Liu, Chuncheng; Yang, Bin; Yang, Ligang; Huang, Shujie; Tucker, Joseph D.

doi:10.1016/s0140-6736(17)33195-1

Cited by 9 publications

(14 citation statements)

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“…We found that HIV test pressure was common among Chinese MSM. This is consistent with the Chinese and global literature on HIV test coercion. The quantitative data revealed that most perpatrators were most commonly regular or casual sex partners, followed by friends.…”

Section: Discussionsupporting

confidence: 91%

Pressured HIV testing “in the name of love”: a mixed methods analysis of pressured HIV testing among men who have sex with men in China

Ong

Wu²,

Huang³

et al. 2018

J Intern AIDS Soc

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Introduction HIV testing has rapidly expanded into diverse, decentralized settings. While increasing accessibility to HIV testing is beneficial, it may lead to unintended consequences such as being pressured to test. We examined the frequency, correlates and contexts of pressured HIV testing among Chinese men who have sex with men (MSM) using mixed methods.MethodsWe conducted an online survey of MSM (N = 1044) in May 2017. Pressured HIV testing was defined as being forced to test for HIV. We conducted logistic regression analysis to determine the associations between pressured HIV testing and socio‐demographic and sexual behavioural factors. Follow‐up interviews (n = 17) were conducted with men who reported pressured testing and we analysed qualitative data using a thematic analysis approach.ResultsNinety‐six men (9.2%) reported experiencing pressure to test for HIV. Regular male sex partners were the most common source of pressure (61%, 59/96), and the most common form of pressure was a threat to end a relationship with the one who was being pressured (39%, 37/96). We found a higher risk of pressured testing in men who had only used HIV self‐testing compared to men who had never self‐tested (AOR 2.39 (95%CI: 1.38 to 4.14)). However, this relationship was only significant among men with low education (AOR 5.88 (95% CI: 1.92 to 17.99)) and not among men with high education (AOR 1.62 (95% CI: 0.85 to 3.10)). After pressured testing, about half of men subsequently tested for HIV (55%, 53/96) without pressure – none reported being diagnosed with HIV. Consistent with this finding, qualitative data suggest that perceptions of pressure existed on a continuum and depended on the relationship status of the one who pressured them. Although being pressured to test was accompanied by negative feelings, men who were pressured into testing often changed their attitude towards HIV testing, testing behaviours, sexual behaviours and relationship with the one who pressured them to test.ConclusionPressured HIV testing was reported among Chinese MSM, especially from men with low education levels and men who received HIV self‐testing. However, in some circumstances, pressure to test helped MSM in several ways, challenging our understanding of the role of agency in the setting of HIV testing.

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Section: Discussionsupporting

confidence: 91%

Pressured HIV testing “in the name of love”: a mixed methods analysis of pressured HIV testing among men who have sex with men in China

Ong

Wu²,

Huang³

et al. 2018

J Intern AIDS Soc

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“…Our study found minimal potential harms associated with syphilis self-testing. The frequency of pressured testing, violence, and coercion after testing observed in our sample was similar to that reported in HIV self-testing in Malawi [42] and in China [26][27][28]. Although the experience of being pressured to take STI tests was perceived to be negative, it could potentially lead to positive change and the adoption of risk-mitigation behaviors.…”

Section: Discussionsupporting

confidence: 76%

“…Experiences of being pressured to take a syphilis self-test were also assessed, a known issue in the use of HIV self-test kits [26,27]. Pressured testing was defined as being forced to take a syphilis test against one's will through physical, verbal, or psychological pressure.…”

Section: Syphilis Self-testing Historymentioning

confidence: 99%

Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

Wang

Cheng

et al. 2019

Clinical Infectious Diseases

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Background Syphilis self-testing may help expand syphilis testing among men who have sex with men (MSM). China has rapidly scaled up human immunodeficiency virus (HIV) self-testing, creating an opportunity for integrated syphilis self-testing. However, there is a limited literature on implementing syphilis self-testing. Methods A cross-sectional online survey was conducted among Chinese MSM in 2018. Participants completed a survey instrument including sociodemographic characteristics, sexual behaviors, syphilis self-testing, and HIV self-testing history. Multivariable logistic regression was conducted to identify correlates of syphilis self-testing. We also recorded potential harms associated with syphilis self-testing. Results Six hundred ninety-nine MSM from 89 cities in 21 provinces in China completed the study. A total of 361/699 (51.7%) men tested for syphilis, of whom 174/699 (24.9%) men used syphilis self-testing. Among 174 who had self-tested, 90 (51.7%) reported that the self-test was their first syphilis test and 161 (92.5%) reported that they undertook syphilis self-testing together with HIV self-testing. After adjusting for covariates, syphilis self-testing was correlated with disclosure of sexual orientation to family or friends (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.32–2.73), reporting 2–5 male sexual partners (aOR, 1.81; 95% CI, 1.04–3.16), HIV self-testing (aOR, 39.90; 95% CI, 17.00–93.61), and never tested for syphilis in the hospital (aOR, 2.96; 95% CI, 1.86–4.72). Self-reported harms associated with syphilis self-testing were minimal. Conclusions Scaling up syphilis self-testing could complement facility-based testing in China among MSM. Self-testing may increase first-time testing and has limited harms. Our findings suggest that syphilis self-testing could be integrated into HIV self-testing services.

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“…In general, women found the ability to bring kits home increased their autonomy and left them feeling empowered by testing themselves and offering HIVST to their male partners. Empowerment for women did leave some men feeling “coerced” to self‐test ; however, most described it as well‐intentioned and socially acceptable within their established partnership , as also reported for men who have sex with men from China . Nevertheless, several cases of coercion escalated into other forms of harm.…”

Section: Discussionmentioning

confidence: 95%

Exploring social harms during distribution of HIV self‐testing kits using mixed‐methods approaches in Malawi

et al. 2019

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Introduction HIV self‐testing (HIVST) provides couples and individuals with a discreet, convenient and empowering testing option. As with all HIV testing, potential harms must be anticipated and mitigated to optimize individual and public health benefits. Here, we describe social harms (SHs) reported during HIVST implementation in Malawi, and propose a framework for grading and responding to harms, according to their severity. Methods We report findings from six HIVST implementation studies in Malawi (2011 to 2017) that included substudies investigating SH reports. Qualitative methods included focus group discussions, in‐depth interviews and critical incident interviews. Earlier studies used intensive quantitative methods (post‐test questionnaires for intimate partner violence, household surveys, investigation of all deaths in HIVST communities). Later studies used post‐marketing reporting with/without community engagement. Pharmacovigilance methodology (whereby potentially life‐threatening/changing events are defined as “serious”) was used to grade SH severity, assuming more complete passive reporting for serious events. Results During distribution of 175,683 HIVST kits, predominantly under passive SH reporting, 25 serious SHs were reported from 19 (0.011%) self‐testers, including 15 partners in eight couples with newly identified HIV discordancy, and one perinatally infected adolescent. There were no deaths or suicides. Marriage break‐up was the most commonly reported serious SH (sixteen individuals; eight couples), particularly among serodiscordant couples. Among new concordant HIV‐positive couples, blame and frustration was common but rarely (one episode) led to serious SHs. Among concordant HIV‐negative couples, increased trust and stronger relationships were reported. Coercion to test or disclose was generally considered “well‐intentioned” within established couples. Women felt empowered and were assertive when offering HIVST test kits to their partners. Some women who persuaded their partner to test, however, did report SHs, including verbal or physical abuse and economic hardship. Conclusions After more than six years of large‐scale HIVST implementation and in‐depth investigation of SHs in Malawi, we identified approximately one serious reported SH per 10,000 HIVST kits distributed, predominantly break‐up of married serodiscordant couples. Both “active” and “passive” reporting systems identified serious SH events, although with more complete capture by “active” systems. As HIVST is scaled‐up, efforts to support and further optimize community‐led SH monitoring should be prioritized alongside HIVST distribution.

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Coercion and HIV self-testing in Chinese men who have sex with men: implementation data from a cross-sectional survey

Cited by 9 publications

References 0 publications

Pressured HIV testing “in the name of love”: a mixed methods analysis of pressured HIV testing among men who have sex with men in China

Pressured HIV testing “in the name of love”: a mixed methods analysis of pressured HIV testing among men who have sex with men in China

Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

Exploring social harms during distribution of HIV self‐testing kits using mixed‐methods approaches in Malawi

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