HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations

Abstract

Despite global efforts to increase HIV test uptake among men who have sex with men (MSM), social stigma and negative attitudes toward homosexuality hinder the effectiveness of traditional test promotion campaigns. Increasing HIV test uptake requires greater understanding of the conditions that facilitate decisions to get tested. We conducted an online survey hosted by two of the most highly frequented MSM web portals in China. A generalised ordered logistic regression analysis was conducted to determine factors associated with HIV testing behaviour. Compared to men who had never tested for HIV, men who had tested in the past year were more likely to have never engaged in sex with women, have multiple male sex partners in the past 3 months and have disclosed their sexual orientation to others. MSM found testing at local Chinese Centers for Disease Control and Prevention (80.7%), gay men’s community-based organisations (80.2%) and public hospitals (70.9%) to be acceptable, while saunas (50.5%) and gay bars (41.8%) were found to be unacceptable testing venues. Our study shows that MSM in China prefer to test at venues that guarantee confidentiality, quality and quick results. Our study also suggests that self-testing may be a feasible approach to increase test uptake.

HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community‐based HIV testing services

“…Additionally, apone clients – men who are sexually oriented towards other men but typically do not openly identify as gay – had seven‐times higher risk of HIV positivity at baseline than thange . Across Asia, non‐disclosure of sexual identity has been associated with higher levels of condomless sex and a lower uptake of testing for HIV and STIs , which may explain some of the increased vulnerability to HIV observed among apone clients in this study. Awareness of sexual orientation is an important precursor to provider‐initiated HIV testing , and non‐disclosure of sexual behaviours may hinder the provision of relevant and tailored sexual health information, including assessments of eligibility for biomedical HIV prevention options.…”

No Place Like Home? Disentangling Preferences for HIV Testing Locations and Services Among Men Who Have Sex with Men in China

“…According to a 2015 national online survey, 46% of MSM in China have never received an HIV test [ 4 ]. One reason Chinese MSM are not testing more frequently may be because of dissatisfaction with current HIV testing service options [ 5 , 6 ]. For example, MSM in China have indicated an affinity for testing in public hospitals and clinics [ 6 ], but concerns about confidentiality surrounding HIV or MSM status may discourage facility-based testing.…”

“…One reason Chinese MSM are not testing more frequently may be because of dissatisfaction with current HIV testing service options [ 5 , 6 ]. For example, MSM in China have indicated an affinity for testing in public hospitals and clinics [ 6 ], but concerns about confidentiality surrounding HIV or MSM status may discourage facility-based testing. Previous studies have qualitatively identified an array of HIV testing service characteristics that Chinese MSM consider when deciding whether to test [ 6 – 11 ], but to date there has been little to no research that has quantitatively examined the relative importance of each HIV testing service characteristic.…”

Lack of Sexual Behavior Disclosure May Distort STI Testing Outcomes

“…Finally we found that MSM who had disclosed their sexual behavior to someone (non-specific disclosure) or their healthcare provider (outside the study context) were more likely to select rectal STI testing compared to urethral testing. Past China research indicated that larger disclosure networks were associated with greater propensity of HIV testing [28,18]. Increased probability of never testing for HIV or syphilis was associated with non-disclosure to anyone or health professionals [41,42].…”

“…Moreover, home-based self testing has had several innovations, such as internet-based testing which obviates the need to see a clinician [13] and social entrepreneurship models that promote self-testing [14]; 2) Substantial heterogeneity in MSM preferences may drive rectal test uptake [15] along with a range of unaccounted factors such as disclosure of sexual behavior (outness); 3) The broader randomized controlled trial (RCT) from which we drew data provided a unique context where all providers were offered rectal testing, allowing us to observe differences in MSM rectal STI uptake [16]. Within these factors, the main barrier for testing is lack of disclosure [17,18]. If MSM are unwilling to disclose their sexual behavior, the likelihood of getting tested is low [19].…”