Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China

Abstract

Diagnosis of HIV is the entry point into the continuum of HIV care; a well-recognized necessary condition for the ultimate prevention of onward transmission. In China, HIV testing rates among men who have sex with men (MSM) are low compared to other high risk subgroups, yet experiences with HIV testing among MSM in China are not well understood. To address this gap and prepare for intervention development to promote HIV testing and rapid linkage to treatment, six focus groups (FGs) were conducted with MSM in Beijing (40 HIV-positive MSM participated in one of four FGs and 20 HIV-negative or status unknown MSM participated in one of two FGs). Major themes reported as challenges to HIV testing included stigma and discrimination related to HIV and homosexuality, limited HIV knowledge, inconvenient clinic times, not knowing where to get a free test, fear of positive diagnosis or nosocomial infection, perceived low service quality, and concerns/doubts about HIV services. Key facilitators included compensation, peer support, professionalism, comfortable testing locations, rapid testing, referral and support after diagnosis, heightened sense of risk through engagement in high-risk behaviors, sense of responsibility to protect self, family and partner support, and publicity via social media. Themes and recommendations were generally consistent across HIV-positive and negative/status unknown groups, although examples of enacted stigma were more prevalent in the HIV-positive groups. Findings from our study provide policy suggestions for how to bolster current HIV prevention intervention efforts to enhance 'test-and-treat' strategies for Chinese MSM.

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

“…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.…”

“…17 Previous studies also suggested some key barriers resulting in suboptimal HIV testing experience among Chinese MSM, such as low perception of HIV risk, inconvenient clinic time/location, HIV stigma/discrimination, name-based testing policy to potentially harm confidentiality, lack of professionalism and low quality in HIV testing service provision. 28,29 …”

Barriers and Facilitators of Linkage to and Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study

“…Details of the study design have been described elsewhere. 27 In short, the Chaoyang Chinese AIDS Volunteer Group (CCAVG), a community-based gay-friendly organization in Beijing, recruited eligible participants. We used a peer-referral snowball recruitment strategy to engage additional participants.…”

“…10 For those not on ART, they are eligible to receive one free CD4 and HIV viral load test each year, but patients have to pay for additional tests. 17 It is worth mentioning that when this policy was established, MSM did not largely represent in the HIV epidemic, and therefore did not receive adequate attention from the government commensurate with its focus on other key populations (e.g., former plasma donors, PWID, FSW). [17][18][19][20][21] Hence, MSMfriendly programs were late in development, often without a clear risk reduction strategy and HIV-related service provision policy.…”

Seeking Male Sexual Partners via Internet and Traditional Venues among Chinese Men Who Have Sex with Men: Implications for HIV Risk Reduction Interventions

“…By 2013, MSM accounted for 21.3 % of all people living with HIV/AIDS (PLWHA) in China [2], and their HIV prevalence increased from 3.0 % in 2006, to 7.6 % in 2013 [2]. Although many HIV prevention intervention programs highlight Chinese MSM as a key population, MSM are documented to continue with a high prevalence of risky behaviors, such as condomless anal sex, substance abuse, multiple sexual partnership and lack of routine HIV testing [3][4][5][6][7]. Hence, continued HIV transmission occurs within and beyond this population through both homosexual and heterosexual contacts [8].…”