Factors associated with past HIV testing among men who have sex with men attending university in China: a cross-sectional study*
Rongyi Ye
A † , Chunfang Liu B † , Shengkui Tan A , Juntong Li A , Jane M. Simoni C , DeAnne Turner D , LaRon E. Nelson E , Sten H. Vermund D , Na Wang A G and Han-Zhu Qian D F G
+ Author Affiliations
- Author Affiliations
A School of Public Health, Guilin Medical University, Guilin, China.
B School of Public Health, Baotou Medical University, Baotou, China.
C Department of Psychology, University of Washington, Seattle, WA, USA.
D School of Public Health, Yale University, New Haven, CT, USA.
E School of Nursing, Yale University, New Haven, CT, USA.
F Xiangya Nursing School, Central South University, Changsha, China.
G Corresponding authors. Email: wangna2413@163.com; han-zhu.qian@yale.edu
Sexual Health 18(1) 58-63 https://doi.org/10.1071/SH20088
Submitted: 26 May 2020 Accepted: 31 August 2020 Published: 16 February 2021
Abstract
Background: HIV prevalence has been rapidly increasing among men who have sex with men (MSM) attending university in China, but HIV testing rates remain suboptimal. The factors associated with past HIV testing in this population in Beijing, China, were investigated. Methods: This study used data from the baseline survey of an HIV intervention clinical trial among MSM who did not have a history of a positive HIV diagnosis. This analysis focused on the HIV testing experience in a subgroup of university student MSM participants. Log-binomial models were used to evaluate factors associated with past HIV testing. Results: Of 375 university student MSM, the median age was 22 years; 89.3% were Han ethnic. Approximately half (50.4%, n = 189) had ever taken an HIV test before the survey. In a multivariable log-binomial model, older age (adjusted prevalence ratio (APR), 1.04; 95% confidence interval (CI), 1.02–1.06), had first sexual intercourse at age <18 years (APR, 1.35; 95% CI, 1.08–1.45) and knew someone living with HIV (APR, 1.33; 95% CI, 1.07–1.61) were associated with a higher likelihood of past testing. Self-reported barriers to taking a test included perceived low HIV risk, fear of a positive diagnosis, did not know where to get tested and fear of discrimination. Facilitators included anonymity in taking a test, confidentiality of testing results and availability of home-based and rapid testing. Conclusions: The HIV testing rate among university student MSM was low. Interventions should be implemented to address structural, institutional and individual barriers to HIV testing in this vulnerable population.
Keywords: China, HIV prevention, HIV testing, male-to-male transmission, men who have sex with men, testing barriers, university students, vulnerable populations.
References
[1] Zhang X, Wang N, Vermund SH, Zou H, Li X, Zhang F, et al Interventions to improve the HIV continuum of care in China. Curr HIV/AIDS Rep 2019; 16 448–57.| Interventions to improve the HIV continuum of care in China.Crossref | GoogleScholarGoogle Scholar | 31776975PubMed |
[2] Chen Q, Sun Y, Sun W, Hao M, Li G, Su X, et al Trends of HIV incidence and prevalence among men who have sex with men in Beijing, China: nine consecutive cross-sectional surveys, 2008–2016. PLoS One 2018; 13 e0201953
| Trends of HIV incidence and prevalence among men who have sex with men in Beijing, China: nine consecutive cross-sectional surveys, 2008–2016.Crossref | GoogleScholarGoogle Scholar | 30543639PubMed |
[3] Yang Z, Huang Z, Dong Z, Zhang S, Han J, Jin M. Prevalence of high-risky behaviors in transmission of HIV among high school and college student MSM in China: a meta-analysis. BMC Public Health 2015; 15 1272
| Prevalence of high-risky behaviors in transmission of HIV among high school and college student MSM in China: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 26690367PubMed |
[4] Zou H, Tucker JD, Fan S, Xu J, Yu M, Luo Z, et al Learning about HIV the hard way: HIV among Chinese MSM attending university. Lancet Infect Dis 2018; 18 16–18.
| Learning about HIV the hard way: HIV among Chinese MSM attending university.Crossref | GoogleScholarGoogle Scholar | 29303730PubMed |
[5] Li Y, Xu J, Reilly KH, Zhang J, Wei H, Jiang Y, et al Prevalence of HIV and syphilis infection among high school and college student MSM in China: a systematic review and meta-analysis. PLoS One 2013; 8 e69137
| Prevalence of HIV and syphilis infection among high school and college student MSM in China: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 24391964PubMed |
[6] Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011; 52 793–800.
| The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection.Crossref | GoogleScholarGoogle Scholar | 21367734PubMed |
[7] Zhang D, Lu H, Zhuang M, Wu G, Yan H, Xu J, et al Enhancing HIV testing and treatment among men who have sex with men in China: a pilot model with two-rapid tests, single blood draw session, and intensified case management in six cities in 2013. PLoS One 2016; 11 e0166812
| Enhancing HIV testing and treatment among men who have sex with men in China: a pilot model with two-rapid tests, single blood draw session, and intensified case management in six cities in 2013.Crossref | GoogleScholarGoogle Scholar | 27997600PubMed |
[8] Xu J, Sonnerborg A, Gao L, Wang P, Bouey JZH, Cheng F. Delayed treatment for people living with HIV in China, 2004–2016: an analysis of an observational cohort. Int J Environ Res Public Health 2020; 17 1809
| Delayed treatment for people living with HIV in China, 2004–2016: an analysis of an observational cohort.Crossref | GoogleScholarGoogle Scholar |
[9] Li R, Pan X, Ma Q, Wang H, He L, Jiang T, et al Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study. BMC Public Health 2016; 16 1152
| Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 27832761PubMed |
[10] World Health Organization (WHO). Consolidated guidelines on HIV testing services for a changing epidemic. Geneva: WHO; 2019. Available online at: https://apps.who.int/iris/bitstream/handle/10665/329966/WHO-CDS-HIV-19.31-eng.pdf [verified 25 July 2020].
[11] McDaid LM, Aghaizu A, Frankis J, Riddell J, Nardone A, Mercey D, et al Frequency of HIV testing among gay and bisexual men in the UK: implications for HIV prevention. HIV Med 2016; 17 683–93.
| Frequency of HIV testing among gay and bisexual men in the UK: implications for HIV prevention.Crossref | GoogleScholarGoogle Scholar | 26991460PubMed |
[12] Woldeyohannes D, Asmamaw Y, Sisay S, Hailesselassie W, Birmeta K, Tekeste Z. Risky HIV sexual behavior and utilization of voluntary counseling and HIV testing and associated factors among undergraduate students in Addis Ababa, Ethiopia. BMC Public Health 2017; 17 121
| Risky HIV sexual behavior and utilization of voluntary counseling and HIV testing and associated factors among undergraduate students in Addis Ababa, Ethiopia.Crossref | GoogleScholarGoogle Scholar | 28122536PubMed |
[13] Xu H, Xie J, Xiao Z, Xiao H, Li X, Goldsamt L, et al Sexual attitudes, sexual behaviors, and use of HIV prevention services among male undergraduate students in Hunan, China: a cross-sectional survey. BMC Public Health 2019; 19 250
| Sexual attitudes, sexual behaviors, and use of HIV prevention services among male undergraduate students in Hunan, China: a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar | 30819255PubMed |
[14] Liu Y, Qian HZ, Ruan Y, Wu P, Osborn CY, Jia Y, et al Frequent HIV testing: impact on HIV risk among Chinese men who have sex with men. J Acquir Immune Defic Syndr 2016; 72 452–61.
| Frequent HIV testing: impact on HIV risk among Chinese men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 27003496PubMed |
[15] Liu Y, Vermund SH, Ruan Y, Liu H, Rivet Amico K, Simoni JM, et al Peer counselling versus standard-of-care on reducing high-risk behaviours among newly diagnosed HIV-positive men who have sex with men in Beijing, China: a randomized intervention study. J Int AIDS Soc 2018; 21 e25079
| Peer counselling versus standard-of-care on reducing high-risk behaviours among newly diagnosed HIV-positive men who have sex with men in Beijing, China: a randomized intervention study.Crossref | GoogleScholarGoogle Scholar | 30649834PubMed |
[16] Bay MB, Freitas MR, Lucas MCV, Souza ECF, Roncalli AG. HIV testing and HIV knowledge among men who have sex with men in Natal, Northeast Brazil. Braz J Infect Dis 2019; 23 2–7.
| HIV testing and HIV knowledge among men who have sex with men in Natal, Northeast Brazil.Crossref | GoogleScholarGoogle Scholar | 30742795PubMed |
[17] Hill AO, Bavinton BR, Armstrong G. Prevalence and correlates of lifetime and recent HIV testing among men who have sex with men (MSM) who use mobile geo-social networking applications in Greater Tokyo. PLoS One 2019; 14 e0209933
| Prevalence and correlates of lifetime and recent HIV testing among men who have sex with men (MSM) who use mobile geo-social networking applications in Greater Tokyo.Crossref | GoogleScholarGoogle Scholar | 30673729PubMed |
[18] Mandiwa C, Namondwe B. Uptake and correlates of HIV testing among men in Malawi: evidence from a national population-based household survey. BMC Health Serv Res 2019; 19 203
| Uptake and correlates of HIV testing among men in Malawi: evidence from a national population-based household survey.Crossref | GoogleScholarGoogle Scholar | 30922321PubMed |
[19] Zhao Y, Zhang L, Zhang H, Xia D, Pan SW, Yue H, et al HIV testing and preventive services accessibility among men who have sex with men at high risk of HIV infection in Beijing, China. Medicine (Baltimore) 2015; 94 e534
| HIV testing and preventive services accessibility among men who have sex with men at high risk of HIV infection in Beijing, China.Crossref | GoogleScholarGoogle Scholar | 26717376PubMed |
[20] Regan S, Losina E, Chetty S, Giddy J, Walensky RP, Ross D, et al Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa. PLoS One 2013; 8 e62362
| Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa.Crossref | GoogleScholarGoogle Scholar | 23626808PubMed |
[21] Zhou J, Chen J, Goldsamt L, Wang H, Zhang C, Li X. HIV testing and associated factors among men who have sex with men in Changsha, China. J Assoc Nurses AIDS Care 2018; 29 932–41.
| HIV testing and associated factors among men who have sex with men in Changsha, China.Crossref | GoogleScholarGoogle Scholar | 29861317PubMed |
[22] Price DM, Howell JL, Gesselman AN, Finneran S, Quinn DM, Eaton LA. Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men. J Behav Med 2019; 42 534–44.
| Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men.Crossref | GoogleScholarGoogle Scholar | 30600404PubMed |
[23] Okal J, Lango D, Matheka J, Obare F, Ngunu-Gituathi C, Mugambi M, et al “It is always better for a man to know his HIV status” – a qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya. PLoS One 2020; 15 e0231645
| “It is always better for a man to know his HIV status” – a qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya.Crossref | GoogleScholarGoogle Scholar | 32294124PubMed |
[24] Okoboi S, Twimukye A, Lazarus O, Castelnuovo B, Agaba C, Immaculate M, et al Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda: a qualitative study. J Int AIDS Soc 2019; 22 e25269
| Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 30932364PubMed |
[25] Tao J, Li MY, Qian HZ, Wang LJ, Zhang Z, Ding HF, et al Home-based HIV testing for men who have sex with men in China: a novel community-based partnership to complement government programs. PLoS One 2014; 9 e102812
| Home-based HIV testing for men who have sex with men in China: a novel community-based partnership to complement government programs.Crossref | GoogleScholarGoogle Scholar | 25265508PubMed |
[26] Njau B, Lisasi E, Damian DJ, Mushi DL, Boulle A, Mathews C. Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania. BMC Public Health 2020; 20 490
| Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania.Crossref | GoogleScholarGoogle Scholar | 32293370PubMed |
[27] Mazur A, Brindis CD, Decker MJ. Assessing youth-friendly sexual and reproductive health services: a systematic review. BMC Health Serv Res 2018; 18 216
| Assessing youth-friendly sexual and reproductive health services: a systematic review.Crossref | GoogleScholarGoogle Scholar | 29587727PubMed |
[28] Fix RL, Letourneau EJ, Mauro PM, McCart MR, Sheidow AJ. Factors promoting and impeding HIV testing among adolescents in juvenile drug court. AIDS Care 2019; 31 177–80.
| Factors promoting and impeding HIV testing among adolescents in juvenile drug court.Crossref | GoogleScholarGoogle Scholar | 30442024PubMed |
