HIV Self-Testing Among Online MSM in China

Han, Larry; Bien, Cedric H.; Wei, Chongyi; Muessig, Kathryn E.; Yang, Min; Liu, Fengying; Yang, Ligang; Meng, Gang; Emch, Michael; Tucker, Joseph D.

doi:10.1097/qai.0000000000000278

Cited by 72 publications

(59 citation statements)

References 24 publications

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“…In this study, we found that a majority of MSM participants in Jiangsu Province, China, where there is a relatively high burden of HIV infections among this population [14], had heard of HIV self-testing and 26.2% had ever self-tested for HIV, a figure similar to a previous study [11]. A majority of participants reported that performing self-testing was “somewhat easy” or “very easy.” However, participants’ confidence in the accuracy of their self-testing results was much lower where only 24.1% said they were “very confident.” In addition, a majority of participants perceived that HIV self-testing was less accurate compared to CDC or hospital provided testing.…”

Section: Discussionsupporting

confidence: 81%

“…A systematic review of HIV self-testing among key populations in other countries found that acceptability of and preference for self-testing was very high and confidentiality and privacy were among the key facilitators of self-testing [10]. A recent study conducted among an online sample of Chinese MSM found that 20.3% of participants have ever self-tested for HIV [11]. One of the concerns of HIV self-testing is that individuals without training or supervision may incorrectly understand test instructions, incorrectly collect the specimens and incorrectly interpret the test results [10].…”

Section: Introductionmentioning

confidence: 99%

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Experiences and Correlates of HIV Self-Testing Among Men Who Have Sex with Men in Jiangsu Province, China

et al. 2014

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Substantial numbers of Chinese men who have sex with men (MSM) do not access facility-based HIV testing. Self-testing could promote testing uptake among this population. We describe experiences and identify correlates of self-testing among Chinese MSM. A cross-sectional survey was conducted among MSM in Jiangsu from November 2013 to January 2014. Participants were recruited through time-location sampling and from online. Participants were asked a series of questions about HIV self-testing uptake and associated experiences. Logistic regression was used to identify correlates of having ever self-tested for HIV. Of 522 participants, 26.2% had ever self-tested. Finger stick was the most common self-testing modality (86.1%). A majority of participants reported that it was “very easy” (43.1%) or “somewhat easy” (34.3%) to perform self-testing while lower proportions reported “very confident” (24.1%) or “somewhat confident” (36.5%) in the accuracy of their test results. Having ever self-tested was significantly associated with having had 2 to 5 and 6 or more male anal sex partners in the past six months (AOR = 2.12, 95% CI: 1.00, 4.49; AOR = 4.95, 95% CI: 1.90, 12.87), having ever tested for HIV (AOR = 4.56, 95% CI: 1.66, 12.55), and having a friend or friends who self-tested (AOR = 7.32, 95% CI: 3.57, 15.00). HIV self-testing can reach untested Chinese MSM and / or increase testing frequency. Peer- or social network-based interventions could help further encourage self-testing. Monitoring systems should be strengthened to ensure the quality of self-testing kits and provision of essential support services, including post-test counseling and linkage-to-care.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Experiences and Correlates of HIV Self-Testing Among Men Who Have Sex with Men in Jiangsu Province, China

et al. 2014

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“…We found MSM who were married were more likely to test for HIV, also noted by Han et al 55 It is possible that the responsibility for their wives or family members motivates men to take HIV tests and to take precautions if they are infected. Some studies have found that younger age was associated with higher HIV testing rates.…”

Section: Discussionsupporting

confidence: 77%

“…However, many MSM do not use this service or fail to return for periodic testing due to a perceived lack of confidentiality in identity and results, long wait-times, and stigma associated with HIV testing. 28,55 Most of our participants thought “anonymity”, “confidentiality of the test results” or “rapid HIV testing” would facilitate their testing activities, while “not knowing where to test” and “perceived low risk of HIV infection” were two of the top three barriers to testing. Successful experiences have demonstrated the benefits of self-testing, such as time/location convenience, protection against privacy disclosure, and increased HIV testing frequency.…”

Section: Discussionmentioning

confidence: 99%

“…Successful experiences have demonstrated the benefits of self-testing, such as time/location convenience, protection against privacy disclosure, and increased HIV testing frequency. 28,29,56,57 Innovative testing provisions, such as the community-initiated home-based counseling and self-testing, should be expanded to see whether they can succeed in involving more Chinese MSM to periodically test for HIV.…”

Section: Discussionmentioning

confidence: 99%

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Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men

Liu

Qian

Ruan³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background The HIV epidemic continues to expand among men who have sex with men (MSM) in China. The NIMH Project Accept/HPTN 043 trial suggested a borderline significant trend towards HIV incidence reduction among persons with higher testing rates. Methods We assessed HIV testing histories and infection status among a community-based Beijing MSM. HIV serostatus was lab-confirmed. We ascertained demographic/behavioral factors via questionnaire-based interviews. Associations of prior HIV testing with odds of current HIV infection were assessed, seeking improved like-with-like risk comparisons through multivariable logistic regression analysis with propensity score adjustment and restricted cubic spline modeling. Results Among 3,588 participants, 12.7% were HIV-infected; 70.8 % reported having ever tested for HIV. Compared to MSM who never tested, those ever testing had a 41% reduction in the odds of being HIV-positive (adjusted odds ratio [aOR], 0.59; 95% confidence interval [CI]: 0.48, 0.74). Higher HIV testing frequencies were associated with a decreasing trend in the odds of being infected with HIV vs. a referent group with no prior testing (>6 tests [aOR: 0.27; 95%CI: 0.18, 0.41]; 4–6 [aOR: 0.55; 95%CI: 0.39, 0.78]; 2–3 [aOR: 0.61; 95%CI: 0.45, 0.82]; P for trend <0.001). The multivariable adjusted model with restricted cubic spline of HIV testing frequency showed a higher frequency of prior HIV testing associated with lower odds of HIV infection, particularly among men with ≥10 lifetime male sexual partners. Conclusions Using risk probability adjustments to enable less biased comparisons, frequent HIV testing was associated with a lower HIV odds among Chinese MSM.

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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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HIV Self-Testing Among Online MSM in China

Cited by 72 publications

References 24 publications

Experiences and Correlates of HIV Self-Testing Among Men Who Have Sex with Men in Jiangsu Province, China

Experiences and Correlates of HIV Self-Testing Among Men Who Have Sex with Men in Jiangsu Province, China

Frequent HIV Testing: Impact on HIV Risk Among Chinese Men Who Have Sex with Men

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

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