Solidarity and HIV Testing Willingness During the COVID-19 Epidemic: A Study Among Men Who Have Sex With Men in China

Background: Solidarity, such as community connectedness and social cohesion, may be useful in improving HIV testing uptake among men who have sex with men (MSM). This study aimed to evaluate the impact of solidarity on HIV testing before the coronavirus disease 2019 (COVID-19) and HIV testing willingness during COVID-19 among MSM in China.Materials and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and solidarity items' information from the participants. We first used factor analysis to reveal the principal component of the solidarity items and then used logistic regression to study the impact of solidarity on HIV testing, by adjusting the possible confounding factors, such as age and education.Results: Social cohesion and community connectedness were revealed by the factor analysis. MSM with high community connectedness were more willing to undergo HIV testing before the epidemic adjusted by age [odds ratio (OR): 1.07, 95% CI: 1.01–1.13]. The community connectedness was also related to the willingness of HIV testing during the epidemic, with adjustments of 1.09 (95% CI: 1.03–1.15). People who did not test for HIV before the COVID-19 epidemic were more willing to have the HIV test during the epidemic, which was correlated with the community connectedness, and the OR value was 1.14 (95%: 1.03–1.25).Conclusion: A high level of community connectedness helped to increase the HIV testing rate before COVID-19 and the willingness of HIV testing during the epidemic among MSM. Strategies can strengthen the role of the community in the management and service of MSM.

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Impacts of the COVID-19 pandemic on HIV testing utilization among men who have sex with men in China: a cross-sectional online survey (Preprint)

10.2196/preprints.30070 ◽

2021 ◽

Author(s):

Ke Chun Zhang ◽

Yuan Fang ◽

He Cao ◽

Hongbiao Chen ◽

Tian Hu ◽

...

Keyword(s):

Hiv Testing ◽

Perceived Risk ◽

Online Survey ◽

Service Providers ◽

Cross Sectional ◽

Factors Associated ◽

Testing Service ◽

Initial Control ◽

Testing Uptake ◽

Sex With Men

BACKGROUND The COVID-19 pandemic creates disruptions on HIV prevention and sexual health services for men who have sex with men (MSM). OBJECTIVE This study compared HIV testing utilization in three different reference periods (i.e., before COVID-19 outbreak, after the outbreak, and after the pandemic was under initial control). Factors associated with HIV testing utilization after COVID-19 outbreak were also investigated. METHODS Participants were Chinese-speaking MSM aged ≥18 years living in Shenzhen, China. Those self-reported as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August to September 2020. HIV testing uptake between February and July 2020 was the dependent variable, and multivariate logistic regression models were fitted. RESULTS About half of the participants reported any HIV testing uptake between February and July 2020 (n=331, 55.6%). As compared to the time before COVID-19 outbreak (November 2019 to January 2020), HIV testing uptake was significantly lower during February and April 2020 (44.0% versus 61.0%, p<.001). However, HIV testing uptake did not increase significantly after the pandemic was under initial control (May to July 2020) (46.6% versus 44.0%, p=.21). After adjusting for significant background characteristics, factors associated with higher HIV testing uptake between February and July 2020 included: 1) HIV testing uptake prior to COVID-19 outbreak (AOR: 10.75, 95%CI: 7.22, 16.02, p<.001), 2) use of sexually transmitted infections (STI) testing (AOR: 7.02, 95%CI: 4.10, 12.02, p<.001), other HIV/STI prevention (AOR: 3.15, 95%CI: 2.16, 4.60, p<.001) and PrEP (AOR: 3.58, 95%CI: 1.54, 8.34, p=.002) between February and July 2020, 3) CAI with RP (AOR: 2.05, 95%CI: 1.34, 3.13, p=.001) and NRP (AOR: 2.49, 95%CI: 1.39, 4.47, p=.002), and SDU (AOR: 2.72, 95%CI: 1.50, 4.94, p=.001) between February and July 2020, 4) perceived risk of HIV infection at present was higher than the time before COVID-19 outbreak (AOR: 1.15, 95%CI: 1.01, 1.30, p=.03), 5) perceived COVID-19 preventive measures taken up by HIV testing service providers to be effective (AOR: 1.52, 95%CI: 1.29, 1.78, p<.001), and 6) perceived higher behavioral control to take up HIV testing after COVID-19 outbreak (AOR: 1.18, 95%CI: 1.00, 1.40, p=.048). Concerns about COVID-19 infection during HIV testing (AOR: 0.78, 95%CI: 0.68, 0.89, p<.001), avoiding crowed places (AOR: 0.68, 95%CI: 0.48, 0.98, p=0.04) and HIV testing service providers reduced their working hours (AOR: 0.59, 95%CI: 0.48, 0.98, p=0.046) were negatively associated with the dependent variable. CONCLUSIONS HIV testing utilization among Chinese MSM declined after COVID-19 outbreak and did not increase after the pandemic received initial control. Removing structural barriers to access HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing might be useful strategies to improve HIV testing among MSM during the pandemic.

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HIV testing uptake and yield among sexual contacts of HIV-positive men who have sex with men in Zhejiang Province, China, 2014-2016: a cross-sectional pilot study of a choice-based partner tracing and testing package

10.21203/rs.2.11001/v1 ◽

2019 ◽

Author(s):

Mingyu Luo ◽

Katrina Hann ◽

Guomin Zhang ◽

Xiaohong Pan ◽

Jun Jiang ◽

...

Keyword(s):

Hiv Testing ◽

Contact Tracing ◽

Hiv Positive ◽

High Risk Population ◽

Newly Diagnosed ◽

Patient Referral ◽

Hiv Test ◽

Testing Uptake ◽

Sexual Contacts ◽

Sex With Men

Abstract Background Measures to effectively expand tracing and testing to identify undiagnosed HIV infections are significant for the control of HIV/AIDS epidemic among men who have sex with men (MSM). We piloted a combination tracing and testing package aimed at improving contact tracing and uptake and yield of HIV testing for sexual contacts of newly diagnosed HIV positive MSM. We describe the package components and outcomes. Methods The choice-based tracing and testing package was piloted in Hangzhou and Ningbo cities, June 2014 to June 2016. The package adopted four modes, including couples HIV counselling and testing (CHCT), information-driven assisted partner notification (IDAPN), peer-assisted HIV self-testing (HIVST), and patient referral. If sexual contacts tested positive, they were invited to enroll in the pilot. Contact tracing continued through selected modes until inability to contact, refusal to test, or positive test results exhausted all contacts. Socio-demographic factors, sexual behaviors between HIV-positive MSM and their sexual contacts were collected, as well as tracing and testing outcomes of each mode. Results Among 2,495 newly diagnosed HIV-positive MSM, 446(18%) were enrolled as index cases (ICs) through two rounds of contact tracing. The ICs disclosed a total of 4,716 sexual contacts, of whom 548 (12%) were reachable. The pilot resulted in a testing uptake of 87%(478/548) and a yield of 16% (74/478) among sexual contacts. Logistic regression analysis showed that the odds of a reachable sexual contact enrolled in information-driven mode taking an HIV test were 90% more than that of one enrolled in patient referral (95%CI:0.8, 4.4). Conclusions Choice-based tracing and testing package is feasible in expanding HIV-testing uptake among sexual contacts of HIV-positive MSM and are feasible for case-finding among a high-risk population. IDAPN may be an acceptable option to reach sexual contacts for whom limited contact information is available.

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Determinants of Recent HIV Self-Testing Uptake Among Men Who Have Sex With Men in Jiangsu Province, China: An Online Cross-Sectional Survey

Frontiers in Public Health ◽

10.3389/fpubh.2021.736440 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jianjun Li ◽

Gifty Marley ◽

Ye Zhang ◽

Yunting Chen ◽

Weiming Tang ◽

...

Keyword(s):

Online Survey ◽

Jiangsu Province ◽

Cross Sectional Survey ◽

Chi Square ◽

Cross Sectional ◽

Bivariate Correlation ◽

Self Testing ◽

Hiv Test ◽

Testing Uptake ◽

Sex With Men

Background: To help inform regarding HIV self-testing (HIVST) upscale, we assessed the determinants of recent HIVST uptake among men who have sex with men (MSM) in Jiangsu province, China.Methods: We conducted a convenience online survey from March to April, 2020 among men aged ≥16 years, who had ever had sex with other men. Statistical analysis included Pearson's chi-square test, bivariate correlation, and multivariable logistic regression. p < 0.05 was considered statistically significant.Results: Of the total 692 participants, 69.5% (481) were aged between 18 and 40 years, and 65.9% (456) had reportedly ever self-tested. Using HIVST for first HIV test (aOR = 1.98, 95% CI: 1.21–3.26), perceiving HIVST as more private (aOR = 1.41, 95% CI: 0.85–2.35), and users not needing to go to a health facility (aOR = 1.68, 95% CI: 1.20–2.34) were associated with recent HIVST as facilitating factors.Conclusion: HIVST uptake rate has increased among Jiangsu MSM and can be further promoted by healthcare workers routinely recommending HIVST to their clients.

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HIV Testing Among Middle-Aged and Older Men Who Have Sex With Men (MSM): A Blind Spot?

American Journal of Men s Health ◽

10.1177/1557988319863542 ◽

2019 ◽

Vol 13 (4) ◽

pp. 155798831986354 ◽

Cited By ~ 2

Author(s):

Alvaro Francisco Lopes Sousa ◽

Artur Acelino Francisco Luz Nunes Queiroz ◽

Inês Fronteira ◽

Luís Lapão ◽

Isabel Amélia Costa Mendes ◽

...

Keyword(s):

Hiv Testing ◽

Online Survey ◽

Older Men ◽

Blind Spot ◽

Multivariate Logistic Regression Model ◽

Middle Aged ◽

Factors Associated ◽

Hiv Test ◽

Sex With Men ◽

Older Msm

Middle-aged and older men who have sex with men (MSM) are one of the most underestimated populations with regard to HIV/AIDS infection, despite the worldwide trend of increasing prevalence in recent years. This population also has low rates of testing, although rare studies are done exclusively with middle-aged and older MSM assessing the factors associated with this prevalence. Thus, based on data from an exclusive online survey with middle-aged and older MSM who use geolocation-based dating applications, the purpose of the study was to analyze factors associated with not taking the HIV test among middle-aged (50 years old) and older MSM in Brazil. Using a modification of time-location sampling adapted to virtual reality, 412 volunteers were approached in Grindr®, Hornet®, SCRUFF®, and Daddyhunt®. The multivariate logistic regression model was adopted to produce adjusted odds ratios (ORa), considering a significance level at .05. There were factors associated with not taking the test: being in a relationship (ORa: 0.24; 95% CI [0.10, 0.53]); knowing partner through the applications (ORa: 1.84; 95% CI [1.07, 3.15]); not knowing the serological status (ORa: 5.07; 95% CI [1.88, 13.67]); ejaculating outside of anal cavity (ORa: 1.79; 95% CI [1.04, 3.05]); practicing sex without penetration (ORa: 2.30; 95% CI [1.17, 4.50]); not taking the test as a form of prevention (ORa: 2.83; 95% CI [1.05, 7.68]); and rarely using Viagra in sexual intercourse (ORa: 1.91; 95% CI [1.20, 3.65]). There is a blind spot in the prevalence of HIV testing in older MSM because this population is not being covered by services, which compromises the overall response to HIV, the goals set for universal health coverage.

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Using individual stated-preferences to optimize HIV self-testing service delivery among men who have sex with men (MSM) in Malaysia: results from a conjoint-based analysis

BMC Public Health ◽

10.1186/s12889-020-09832-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Roman Shrestha ◽

Haridah Alias ◽

Li P. Wong ◽

Frederick L. Altice ◽

Sin H. Lim

Keyword(s):

Service Delivery ◽

Hiv Testing ◽

Online Survey ◽

Stated Preference ◽

Relative Importance ◽

Cross Sectional ◽

Self Testing ◽

Telephone Hotline ◽

Testing Uptake ◽

Sex With Men

Abstract Background HIV self-testing (HIVST) has the potential to improve HIV testing uptake and frequency for key populations like MSM who experience multiple barriers accessing clinic-based HIV testing. In the absence of HIVST in Malaysia, there is no guidance to inform HIVST delivery. This study investigated the acceptability of HIVST and preferences about the HIVST service delivery approaches using a standardized stated preference method. Methods A cross-sectional online survey conducted between January and April 2019 assessed the interest in HIVST in 544 MSM in Malaysia. Participants ranked eight hypothetical HIVST service delivery program elements with varied combinations of six, two-level HIVST service delivery program attributes (cost, privacy, accuracy, kit collection site, kit type, and testing support). SPSS conjoint procedure was used to estimate the relative importance of each attribute and preference across eight possible HIVST service delivery programs. Results Overall, 70.4% had previously tested for HIV, and of those, 64.0% had done so in the past 6 months (45.0% of all participants). Of all the participants, 25.2% reported having used HIVST previously. The acceptability for HIVST service delivery models ranged from 44.9 to 77.1%, with mean acceptability of 56.2% across the eight hypothetical HIVST distribution scenarios. The HIVST service delivery scenario with the highest acceptability had the following attributes: no cost (free), anonymity (name not required), 99–100% accuracy, home-delivered, fingerstick, and testing support using telephone hotline or texting. HIVST cost was the most important attribute (relative importance score: RIS = 19.30) associated with acceptability, followed by anonymity (RIS = 18.41), accuracy (RIS = 17.33), kit delivery (RIS = 16.99), fingerstick kit (RIS = 15.86), and support (RIS = 12.08). Conclusions Acceptability for HIVST in Malaysian MSM was high but differed markedly by a number of HIVST delivery scenarios and attributes. These findings could be relevant as the Malaysian Ministry of Health is in the process of developing a regulatory framework for ensuring the quality of kits, as well as policies supporting safe use while broader implementation under national AIDS programs.

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Relationship between self-efficacy and HIV testing uptake among young men who have sex with men in Myanmar: a cross-sectional analysis

International Journal of STD & AIDS ◽

10.1177/0956462418791945 ◽

2018 ◽

Vol 30 (1) ◽

pp. 20-28 ◽

Cited By ~ 2

Author(s):

Minh D Pham ◽

Poe Poe Aung ◽

Paul A Agius ◽

Naanki Pasricha ◽

Swai Mon Oo ◽

...

Keyword(s):

Hiv Testing ◽

Self Efficacy ◽

Psychosocial Factor ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

The Past ◽

Hiv Test ◽

Young Msm ◽

Testing Uptake ◽

Sex With Men

Men who have sex with men (MSM) are disproportionally affected by the HIV epidemic. Self-efficacy is an important individual psychosocial factor associated with access to and use of health and HIV-related services. We estimated HIV testing prevalence and examined the relationship between HIV testing self-efficacy and self-reported HIV testing behavior among young MSM (YMSM) in Myanmar. We enrolled 585 MSM aged 18–24 years from six urban areas using respondent-driven sampling (RDS) technique. RDS analyses were performed to provide estimates for the key outcome of interest. More than a third (34.5%) had never been tested for HIV, whereas 27.5% and 38.0% had their most recent HIV test more than three months and within the past three months from the time of interview, respectively. Young MSM who reported high self-efficacy (adjusted relative risk ratio [ARR]=7.35, 95%CI = 2.29–23.5) and moderate self-efficacy (ARR = 8.61, 95%CI = 3.09–24.0) were more likely to report having tested for HIV in the past three months compared to their counterparts who reported low self-efficacy. Findings highlight a positive association between self-efficacy and HIV testing uptake, indicating a potential causal relationship. Further research is needed to examine the direction of this association and inform future public health interventions targeting YMSM in Myanmar.

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The Impact of Homophobia and HIV Stigma on HIV Testing Uptake Among Chinese Men Who Have Sex With Men

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000000815 ◽

2016 ◽

Vol 71 (1) ◽

pp. 87-93 ◽

Cited By ~ 31

Author(s):

Chongyi Wei ◽

Doug H. Cheung ◽

Hongjing Yan ◽

Jianjun Li ◽

Ling-en Shi ◽

...

Keyword(s):

Hiv Testing ◽

Hiv Stigma ◽

Chinese Men ◽

Testing Uptake ◽

Sex With Men ◽

The Impact

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Planning prompts to promote uptake of HIV services among men: a randomised trial in rural Uganda

BMJ Global Health ◽

10.1136/bmjgh-2020-003390 ◽

2020 ◽

Vol 5 (11) ◽

pp. e003390

Author(s):

Nolan M Kavanagh ◽

Elisabeth M Schaffer ◽

Alex Ndyabakira ◽

Kara Marson ◽

Diane V Havlir ◽

...

Keyword(s):

Hiv Testing ◽

Community Health ◽

Control Group ◽

Health Campaign ◽

Percentage Point Increase ◽

Percentage Points ◽

Point Increase ◽

Cost Planning ◽

Testing Uptake ◽

The Impact

IntroductionInterventions informed by behavioural economics, such as planning prompts, have the potential to increase HIV testing at minimal or no cost. Planning prompts have not been previously evaluated for HIV testing uptake. We conducted a randomised clinical trial to evaluate the effectiveness of low-cost planning prompts to promote HIV testing among men.MethodsWe randomised adult men in rural Ugandan parishes to receive a calendar planning prompt that gave them the opportunity to make a plan to get tested for HIV at health campaigns held in their communities. Participants received either a calendar showing the dates when the community health campaign would be held (control group) or a calendar showing the dates and prompting them to select a date and time when they planned to attend (planning prompt group). Participants were not required to select a date and time or to share their selection with study staff. The primary outcome was HIV testing uptake at the community health campaign.ResultsAmong 2362 participants, 1796 (76%) participants tested for HIV. Men who received a planning prompt were 2.2 percentage points more likely to test than the control group, although the difference was not statistically significant (77.1% vs 74.9%; 95% CI –1.2 to 5.7 percentage points, p=0.20). The planning prompt was more effective among men enrolled ≤40 days before the campaigns (3.6 percentage-point increase in testing; 95% CI –2.9 to 10.1, p=0.27) than among men enrolled >40 days before the campaigns (1.8 percentage-point increase; 95% CI –2.3 to 5.8, p=0.39), although the effects within the subgroups were not significant.ConclusionThese findings suggest that planning prompts may be an effective behavioural intervention to promote HIV testing at minimal or no cost. Large-scale studies should further assess the impact and cost-effectiveness of such interventions.

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Factors associated with HIV testing among traditional healers and their clients in rural Uganda: Results from a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/09564624211015028 ◽

2021 ◽

pp. 095646242110150

Author(s):

Doreen Nabukalu ◽

Matthew Ponticiello ◽

Thomas Bennett ◽

Sunday Clark ◽

Rachel King ◽

...

Keyword(s):

Rural Communities ◽

Hiv Testing ◽

Cross Sectional Study ◽

Traditional Healers ◽

Sectional Study ◽

Cross Sectional ◽

The Past ◽

Male Clients ◽

Hiv Test ◽

Testing Uptake

Uptake of HIV testing is suboptimal in Uganda, particularly in rural communities. Reaching UNAIDS 95-95-95 goals requires strategies to increase HIV testing among hard-to-reach populations. This cross-sectional study sought to characterize engagement with HIV testing among traditional healers and their clients in rural Uganda. We enrolled 175 traditional healers and 392 adult clients of healers in Mbarara District. The primary outcome for this study was having received an HIV test in the prior 12 months. Most clients ( n = 236, 65.9%) had received an HIV test within 12 months, compared to less than half of healers ( n = 75, 46.3%) who had not. In multivariate regression models, male clients of healers were half as likely to have tested in the past year, compared with female (adjusted odds ratios (AORs) = 0.43, 95% CI = 0.26–0.70). Increasing age negatively predicted testing within the past year (AOR = 0.95, 95% CI = 0.93–0.97) for clients. Among healers, more sexual partners predicted knowing ones serostatus (AOR = 1.6, 95% CI 1.03–2.48). Healers (AOR = 1.16, 95% CI 1.07–1.26) and clients (AOR = 1.28, 95% CI 1.13–1.34 for clients) with greater numbers of lifetime HIV tests were more likely to have tested in the past year. Traditional healers and their clients lag behind UNAIDS benchmarks and would benefit from programs to increase HIV testing uptake.

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Feasibility of Indirect Secondary Distribution of HIV Self-Test Kits via WeChat Among Men Who Have Sex with Men: A National Cross-Sectional Study in China (Preprint)

10.2196/preprints.28508 ◽

2021 ◽

Author(s):

Li Shangcao ◽

Jing Zhang ◽

Xiang Mao ◽

Tianyi Lu ◽

Yangyang Gao ◽

...

Keyword(s):

Social Media ◽

Online Survey ◽

Sexual Partners ◽

Cross Sectional ◽

Self Testing ◽

Hiv Test ◽

Condomless Anal Intercourse ◽

Secondary Distribution ◽

Self Test ◽

Sex With Men

BACKGROUND The use of HIV self-test (HST) kits is commonplace in key sexually active populations. The direct secondary distribution of HST kits (DSDHK) is effective in improving the uptake of HIV self-testing. However, there are concerns about various limitations of DSDHK, including limited geographic location, payment problems, and face-to-face interaction. OBJECTIVE We evaluated the feasibility and characteristics of the indirect secondary distribution of HST kits (ISDHK) via WeChat (distributing HST application links and follow-up HST kits to partners) among men who have sex with men (MSM). METHODS From October 2017 to September 2019, an HIV self-testing (HIVST) recruitment advertisement was disseminated on the WeChat social media platform to invite MSM to apply for HST kits (referred to as “index participants” [Ips]). All of the MSM participants were encouraged to distribute the HST application link to their friends and sexual partners (referred to as “Alters”) through their social networks. All Alters were further encouraged to continue to distribute the HST application link. All participants paid a deposit (USD 7), refundable upon completion of the questionnaire and uploading of the test result via an online survey system. RESULTS 2,263 MSM met the criteria and successfully applied for HST. Of these, 1,816 participants returned their HST test results, including 1,422 (88.3%) IPs and 394 (21.7%) Alters. Compared with the IPs, the Alters practiced more condomless anal intercourse (CAI), a higher proportion of them never previously had an HIV test, and they had a greater willingness to distribute HST kits to sexual partners (all p < 0.05). After controlling for age, education, and income, the Alters had a greater proportion of MSM who had never tested for HIV before (aOR = 1.29, 95% CI 1.00–1.68), were more willing to distribute the HST application link (aOR = 1.71, 95% CI 1.21–2.40), had a lower number of sexual partners (aOR = 0.71, 95% CI 0.57–0.90), and were less likely to search for sexual partners via online means (aOR = 0.78, 95% CI 0.60–1.02). In comparison, the rates of reactive HST results, conducting HIV confirmatory tests, HIV seropositivity, and initiation of HIV antiretroviral therapy (ART) were similar for IPs and Alters. CONCLUSIONS The ISDHK mode of distributing HST application links via social media is feasible among the MSM population. The ISDHK mode should be used to supplement the DSDHK mode in order to enable a greater proportion of the MSM population to know their HIV infection status.

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