Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross‐sectional online survey

Abstract

Introduction: HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China.Methods: MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing.Results: 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98–12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16–9.04).Conclusions: HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.

Leading by Example: Web-Based Sexual Health Influencers Among Men Who Have Sex With Men Have Higher HIV and Syphilis Testing Rates in China (Preprint)

“…This is consistent with previous studies that found community engagement in sexual health to be associated with increased HIV testing and syphilis testing [35]. This suggests that influencers could be helpful in promoting dual HIV/syphilis testing, given that these related infections often co-occur among MSM in China [39].…”

“…After adjusting for the intervention, influencers in our study also had a higher likelihood of HIV testing. Their higher HIV testing may be related to increased community engagement in sexual health [35] and HIV testing-related social media use. [37] The higher rates of HIV testing among influencers may also be related to lower HIV stigma and higher testing self-efficacy which are two important contributors to test uptake [32,38].…”

Transplantation or rurality? Migration and HIV risk among Chinese men who have sex with men in the urban areas

“…Formal mechanisms to solicit feedback from patients, members of the LGBTQ community, and persons of rural background in the city and countryside should be considered as part of intervention design. Community participatory methods such as crowdsourcing may also be helpful for soliciting community feedback . Second, our findings underscore the urgent need for interventions to address structural barriers to sexual health services, such as lack of HIV/STD awareness among rural transplant MSM or institutional stigma in healthcare settings, beyond just those seeking to affect individual behaviours of rural transplant community.…”

Bridging the HIV-syphilis testing gap: dual testing among men who have sex with men living in China

“…There may be ascertainment bias where the report of dual testing may be systematically underestimated if men who received HIV testing were not told they were also tested for syphilis by the testing provider. Triangulating self-reported data with clinic databases would increase the accuracy of our findings but this was not practical, and other studies have similarly used self-reports to estimate syphilis testing in MSM 10. While our study focused on patient factors, an important area for future research would be to further explore physician factors for offering a single HIV test compared with dual testing.…”