MSM Behavior Disclosure Networks and HIV Testing: An Egocentric Network Analysis Among MSM in China

Abstract

Men who have sex with men (MSM) disclose same-sex behaviors with others, creating disclosure networks. This study examined the characteristics of disclosure networks that are associated with HIV testing among MSM in China through an online nationwide survey. Name-generator questions were used to ask each participant ("ego") to nominate up to five social network members ("alters") with whom he had disclosed same-sex behaviors. Among the 806 men, the average disclosure network size was 4.05. MSM who reported larger disclosure networks were more likely to have been tested for HIV (aOR =1.21, 95%CI: 1.08-1.34). The most common disclosure network alters were friends (45.1%), followed by sex partners (18.7%) and healthcare professionals (2.5%). Men who disclosed to healthcare professionals were more likely to test for HIV compared to men who disclosed to family members (aOR =5.43, 95%CI: 2.11-14.04). Our findings can inform disclosure network-based interventions to promote MSM HIV testing.

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].…”

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 [18,28]. Increased probability of never testing for HIV or syphilis was associated with non-disclosure to anyone or health professionals [41,42].…”

“…Option four indicates disclosure to health providers, which is key to receiving appropriate healthcare [27], more so than the other group specific disclosure options. For example, men out to their healthcare provider are more likely to get HIV testing compared to those out to their family [28]. Although participants attended a specialized MSM testing clinic, this does not reflect their disclosure to their primary care or other health providers.…”

Social network distribution of syphilis self-testing among men who have sex with men in China: study protocol for a cluster randomized control trial

“…Facility-based testing or self-testing history of syphilis, HIV and other STIs, and treatment experience will also be collected. A set of questions including a scale to measure social support, community leadership, and the size of their social network will be asked [ 24 , 25 ].…”