Coerced syphilis self-testing among men who have sex with men: a nationwide cross-sectional study in China

Abstract

Background Syphilis testing uptake remains low among men who have sex with men (MSM) in many low-and middle-income countries. Syphilis self-testing is an efficacious approach on increasing syphilis testing coverage. However, one unintended consequence is the syphilis self-testing coercion from others (including partners, healthcare providers, friends, etc.). This study aimed to examine the prevalence, pattern and correlates of coerced syphilis self-testing among MSM in China. Methods A nationwide online cross-sectional study was conducted from 14 to 28 July 2018. Sociodemographic characteristics, sexual behaviors and coerced syphilis self-testing variables were collected through a questionnaire that targeted MSM in China. Multivariable logistic regression was used to explore associated factors with syphilis self-testing coercion. Results Overall, 174 MSM were recruited in this study, 31 men (17.8%) reported ever experiencing syphilis self-testing coercion. The most common types of coercion before syphilis self-testing were verbal abuse (38.7%, 12/31) and threatening to end a relationship (38.7%, 12/31). After obtaining the self-test results, men were mostly subjected to end a relationship (45.2%, 14/31) and threaten of violence (35.5%, 11/31). Multivariable logistic regression indicated that men who used condoms inconsistently in the past three months, ever used substances before or during sex, ever had group sex with males and commercial sex were more likely to experience syphilis self-testing coercion. Conclusions Coerced syphilis self-testing was prevalent among MSM in China. Innovative intervention to reduce coerced syphilis self-testing is necessary among MSM in China.

Epidemiological characteristics of syphilis in mainland China, 2004 to 2019

“…9 The proliferation of smartphones and the use of social media to seek partners may also have resulted in elevated rates of high-risk sexual behaviors. 14,15 Syphilis incidence fluctuated but generally increased from 2004 to 2019 across Chinese provinces. The provinces and municipalities with the highest syphilis incidences were clustered along the eastern coast (e.g., Shanghai, Zhejiang, Guangxi, Fujian, and Guangdong) and in northwestern regions (e.g., Xinjiang, Ningxia, and Qinghai).…”

The prevalence and correlates of unintended pregnancy among female sex workers in South China: a cross-sectional study

“…3 Southern Medical University Institute for Global Health, Guangzhou, 510095, China. 4 Johns Hopkins Bloomberg School of Public Health, Baltimore, USA…”

“…Unintended pregnancy rates among FSW in Afghanistan, Swaziland, and Kenya were found to be high, ranging from 36.9-52% [2]. In China, the estimated prevalence of unintended pregnancy among FSW ranges from 11.3-46.5% [3,4].…”

“…Hence, interventions to mitigate unintended pregnancy are warranted, which should be designed based on a comprehensive understanding of the factors in uencing unintended pregnancies from the perspective of FSW. However, research to date focusing on unintended pregnancy among Chinese FSW is rare and limited to report the prevalence rates without exploring the underlying determinants [3,4]. Hence, the purpose of this study was to examine experience of unintended pregnancy due to commercial sex and its determinants among FSW in South China.…”