HIV-testing patterns and psycho-social factors associated with frequency of testing by men who have sex with men: implication for scaling up HIV testing in China
Mackey R. Friedman
James E. Egan
The HIV epidemic is growing among men who have sex with men (MSM) in China. Frequent HIV testing is associated with reduced HIV risk among MSM. However, little is known about factors associated with frequency of HIV testing in this population. We aimed to characterise sociodemographic characteristics and psychosocial factors associated with frequent HIV testing in HIV-negative MSM in Guangzhou, China.
We did this cross-sectional survey among MSM who were visiting a gay-friendly community clinic in Guangzhou between Sept 2 and Nov 24, 2016. Men were eligible if they were aged 18 years or more, self-identified biological males, and reported sexual contact with male partners in the past 12 months. Surveys were self-administered via a handheld electronic tablet. We collected sociodemographic characteristics and psychosocial measurements. HIV testing frequency was defined by three groups based on testing history: never tested, irregularly tested, or frequently tested. Irregularly tested MSM tested less than twice per year or tested less than every 6 months. Frequently tested MSM tested twice per year or tested more than once every 6 months. We compared sociodemographic and psychosocial measurements among MSM who never tested, irregularly tested, and frequently tested using χ2 testing or one-way ANOVA. Multinomial logistic regression and ordinal logistic regression were used to identify independent correlates that were associated with differences in frequency of HIV testing. Ethics approval was obtained from the ethics review boards of the Guangzhou Center for Disease Control and Prevention and the University of Pittsburgh.
495 MSM participated in this survey. Three participants refused to answer HIV testing history information and were excluded from this present analysis. Among the 492 MSM, 67 (13·6%) were never tested, 207 (42·1%) were tested irregularly, and 218 (44·3%) were tested frequently in the past 2 years. MSM who tested for HIV frequently were more likely to be older (p=0·001), reside in Guangzhou (p=0·016), and have higher monthly income (p=0·016). Compared with MSM who tested frequently, MSM who never tested were less likely to report that their sexual partner had ever received HIV tests (adjusted odds ratio 0·27; 95% CI 0·11–0·63) or that their good friends had ever received HIV tests (0·42; 0·22–0·78). Compared with MSM who tested frequently, those who never tested were also less likely to report having HIV-positive gay friend (0·39; 0·19–0·78) or ever discussing HIV with sexual partners (0·24; 0·12–0·47); they were more likely to report perceiving barriers to HIV testing (1·13; 1·03–1·24). Compared with MSM who tested frequently, those who tested irregularly were less likely to report having HIV-positive gay friends (0·65; 0·43–0·97) or to disclose their sexual orientation to non-gay friends (0·59; 0·38–0·92). Compared with MSM who tested frequently, those who teested irregularly reported greater barriers to HIV testing (1·07; 1·01–1·13) and higher internalised homophobia (1·06; 1·01–1·11). Ordinal logistic regression showed HIV testing frequency was associated with HIV testing by sexual partners and good friends, knowing gay friends who were HIV-positive, discussing HIV with sexual partners, disclosing sexual orientation to non-gay friends, barriers to HIV testing, and internalised homophobia.
Frequency of HIV testing could be improved among sexually active, HIV-negative MSM in Guangzhou, China. Enhanced interventions using HIV testing promotion via social networks, reducing structural barriers to HIV testing, and creating a gay-friendly environment could increase the frequency of HIV testing among MSM and increase the percentage of HIV-positive MSM receiving antiretroviral therapy, thus contributing to reducing HIV incidence in this population.