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

Abstract

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.

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

“…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.…”

“…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. A prior study documented that HIV testing frequency subsequently increased for the majority of participants who reported that they had been pressured to take an HIV test [27].…”

“…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.…”

“…Pressured testing was defined as being forced to take a syphilis test against one's will through physical, verbal, or psychological pressure. Categories of pressure were defined as physical violence (eg, pushing, slapping, punching, kicks), threats of violence, verbal abuse (eg, being shouted at), psychological pressure (eg, being neglected, being discriminated), excessive control of activities (eg, not being allowed to leave the house), withholding of household resources, and threats to end a relationship [27].…”

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

“…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.…”