Strategies for Promoting HIV Testing Uptake
Strategies for Promoting HIV Testing Uptake
Objectives Low rates of HIV testing drive the rapidly growing HIV epidemic among men who have sex with men (MSM) in China. We examined the potential usefulness of couple-based and collective HIV testing strategies among Chinese MSM.
Methods A cross-sectional online survey was conducted among 1113 MSM in 2013. Multivariable logistic regression analyses were conducted to identify factors associated with willingness to receive couple-based and collective testing.
Results Acceptability of couple-based testing was very high among participants (86.1%), with a moderate level of interest in collective testing (43.2%). Being 'out' to others about one's sexual identity (adjusted OR (AOR)=1.48, 95% CI 1.01 to 2.17) and having ever had an HIV test (AOR=3.05, 95% CI 2.10 to 4.33) were associated with willingness to receive couple-based testing. Having multiple male anal sex partners in the past 3 months was associated with willingness to participate in collective testing (AOR=1.43, 95% CI 1.03 to 1.99).
Discussion Couple-based and collective HIV testing could help better control the HIV epidemic among Chinese MSM if implemented and promoted in a culturally competent manner.
HIV testing is one of the few effective HIV prevention tools and is a critical first step in the HIV care continuum. Recent scientific advances have called for increased efforts to promote HIV testing uptake among key populations worldwide. The Chinese government has prioritised HIV testing as a key strategy to control the rapidly growing HIV epidemic among men who have sex with men (MSM), who now account for over a third of new HIV infections in the country. However, significant individual, sociocultural, and structural barriers (eg, fear of positive results, HIV stigma and gay-related discrimination) exist that discourage Chinese MSM from seeking HIV testing services. A recent meta-analysis reported that prevalence of HIV testing in the past year among Chinese MSM was only 38% and only 47% of MSM have ever been tested. To more effectively control the HIV epidemic among MSM in China, new strategies are needed to significantly increase HIV testing uptake among this disproportionately affected population.
Couple-based testing, where couples participate in the entire cycle of HIV counselling and testing together including receiving their test results as a couple, has been shown to effectively reduce HIV transmission among serodiscordant heterosexual couples in Africa through risk reduction counselling tailored to the couples' HIV sero-status. However, couple-based testing for MSM has not been widely used and received little attention until recently. Several studies conducted in North America, Brazil, Australia, UK, South Africa and Thailand reported high levels of willingness (well over 80%) to use couple-based HIV testing services among MSM. Studies of US gay male couples reported that nearly 20% of HIV-negative men had not been tested for HIV since they have been in their relationship, but expressed interest in participating in couple-based testing. Furthermore, a randomised controlled trial conducted with US MSM found that couple-based testing was safe for male couples, and it was equally acceptable to individual HIV testing for men who have main partners. A few studies conducted with Chinese MSM reported that having a new partner, being asked by a partner or boyfriend, and a sense of responsibility to protect partners from HIV infection facilitate men's decisions to get tested. These findings suggest that couple-based testing could be a useful strategy to promote HIV testing among Chinese MSM. In fact, a male couples HIV counselling and testing programme piloted at a community-based organisation in Chengdu received positive feedback, and the China Centers for Disease Control and Prevention (CDC) has started to incorporate a male couples counselling and testing curriculum into the national training plan for counsellors.
Collective testing, defined here as two or more socially connected individuals, instead of romantic or sex partners participating in HIV counselling and testing together in one setting, may offer another strategy to help Chinese MSM overcome barriers to testing. In Western cultures where individualism is emphasised, obtaining an HIV test is a very private and personal matter. However, within the Chinese collectivist cultural context, processes of dealing with health-related issues often involve agents beyond the directly affected individual. Typically, these agents involve immediate family members and sometimes extended family members. However, due to social stigma attached to homosexuality and MSM behaviour, few Chinese MSM are 'out' (ie, disclosure of gay or bisexual identity) to their families. Thus, when it comes to managing HIV-related health issues such as HIV testing, MSM may seek support from other MSM friends. In a qualitative study of MSM in Nanjing, some participants reported that they had their first HIV testing experience with close friends. Furthermore, collective testing takes advantage of MSM's existing social networks. Studies conducted in the USA showed that network-based approaches were able to locate unrecognised HIV infections among high-risk MSM. A collective testing format could appeal to first-time testers by helping to reduce their fear of testing while receiving social support to cope with the potential stress from stigmas related to HIV/AIDS and having a sexual minority status.
We conducted an online survey among Chinese MSM to examine the acceptance and potential usefulness of couple-based and collective HIV testing strategies. In this paper, we describe MSM willingness to use couple-based and collective HIV testing and associated factors.
Abstract and Introduction
Abstract
Objectives Low rates of HIV testing drive the rapidly growing HIV epidemic among men who have sex with men (MSM) in China. We examined the potential usefulness of couple-based and collective HIV testing strategies among Chinese MSM.
Methods A cross-sectional online survey was conducted among 1113 MSM in 2013. Multivariable logistic regression analyses were conducted to identify factors associated with willingness to receive couple-based and collective testing.
Results Acceptability of couple-based testing was very high among participants (86.1%), with a moderate level of interest in collective testing (43.2%). Being 'out' to others about one's sexual identity (adjusted OR (AOR)=1.48, 95% CI 1.01 to 2.17) and having ever had an HIV test (AOR=3.05, 95% CI 2.10 to 4.33) were associated with willingness to receive couple-based testing. Having multiple male anal sex partners in the past 3 months was associated with willingness to participate in collective testing (AOR=1.43, 95% CI 1.03 to 1.99).
Discussion Couple-based and collective HIV testing could help better control the HIV epidemic among Chinese MSM if implemented and promoted in a culturally competent manner.
Introduction
HIV testing is one of the few effective HIV prevention tools and is a critical first step in the HIV care continuum. Recent scientific advances have called for increased efforts to promote HIV testing uptake among key populations worldwide. The Chinese government has prioritised HIV testing as a key strategy to control the rapidly growing HIV epidemic among men who have sex with men (MSM), who now account for over a third of new HIV infections in the country. However, significant individual, sociocultural, and structural barriers (eg, fear of positive results, HIV stigma and gay-related discrimination) exist that discourage Chinese MSM from seeking HIV testing services. A recent meta-analysis reported that prevalence of HIV testing in the past year among Chinese MSM was only 38% and only 47% of MSM have ever been tested. To more effectively control the HIV epidemic among MSM in China, new strategies are needed to significantly increase HIV testing uptake among this disproportionately affected population.
Couple-based testing, where couples participate in the entire cycle of HIV counselling and testing together including receiving their test results as a couple, has been shown to effectively reduce HIV transmission among serodiscordant heterosexual couples in Africa through risk reduction counselling tailored to the couples' HIV sero-status. However, couple-based testing for MSM has not been widely used and received little attention until recently. Several studies conducted in North America, Brazil, Australia, UK, South Africa and Thailand reported high levels of willingness (well over 80%) to use couple-based HIV testing services among MSM. Studies of US gay male couples reported that nearly 20% of HIV-negative men had not been tested for HIV since they have been in their relationship, but expressed interest in participating in couple-based testing. Furthermore, a randomised controlled trial conducted with US MSM found that couple-based testing was safe for male couples, and it was equally acceptable to individual HIV testing for men who have main partners. A few studies conducted with Chinese MSM reported that having a new partner, being asked by a partner or boyfriend, and a sense of responsibility to protect partners from HIV infection facilitate men's decisions to get tested. These findings suggest that couple-based testing could be a useful strategy to promote HIV testing among Chinese MSM. In fact, a male couples HIV counselling and testing programme piloted at a community-based organisation in Chengdu received positive feedback, and the China Centers for Disease Control and Prevention (CDC) has started to incorporate a male couples counselling and testing curriculum into the national training plan for counsellors.
Collective testing, defined here as two or more socially connected individuals, instead of romantic or sex partners participating in HIV counselling and testing together in one setting, may offer another strategy to help Chinese MSM overcome barriers to testing. In Western cultures where individualism is emphasised, obtaining an HIV test is a very private and personal matter. However, within the Chinese collectivist cultural context, processes of dealing with health-related issues often involve agents beyond the directly affected individual. Typically, these agents involve immediate family members and sometimes extended family members. However, due to social stigma attached to homosexuality and MSM behaviour, few Chinese MSM are 'out' (ie, disclosure of gay or bisexual identity) to their families. Thus, when it comes to managing HIV-related health issues such as HIV testing, MSM may seek support from other MSM friends. In a qualitative study of MSM in Nanjing, some participants reported that they had their first HIV testing experience with close friends. Furthermore, collective testing takes advantage of MSM's existing social networks. Studies conducted in the USA showed that network-based approaches were able to locate unrecognised HIV infections among high-risk MSM. A collective testing format could appeal to first-time testers by helping to reduce their fear of testing while receiving social support to cope with the potential stress from stigmas related to HIV/AIDS and having a sexual minority status.
We conducted an online survey among Chinese MSM to examine the acceptance and potential usefulness of couple-based and collective HIV testing strategies. In this paper, we describe MSM willingness to use couple-based and collective HIV testing and associated factors.
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