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Yang L, Sun Z. Are All Gay Men at Risk of Developing HIV/AIDS? Why China's Mass HIV Testing Has Majorly Targeted Gay Men in the Era of Biomedicalization. Am J Mens Health 2024; 18:15579883241230165. [PMID: 38321807 PMCID: PMC10851740 DOI: 10.1177/15579883241230165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Global HIV/AIDS responses have been increasingly biomedically dominated over the past years. In line with this shifting paradigm, China has prioritized mass HIV testing as a practical approach to controlling its HIV/AIDS epidemics among at-risk populations, especially gay men and other men who have sex with men (MSM). This study analyzed why China's mass HIV testing mainly targeted gay men by understanding the perspectives of public health professionals, community-based organization (CBO) workers, and gay men. In addition, this study revealed the tensions and unintended consequences of HIV/AIDS prevention and the representation of gay men in China. The study involved fieldwork conducted in a major city in Eastern China from 2015 to 2019. Semi-structured interviews were held with participants from the three abovementioned groups (N = 25). The study identified four processes concerning why gay men are mainly targeted for HIV testing. Some public health professionals believe that being a gay man is equivalent to having HIV/AIDS risks. In addition, this study particularly noted tensions between public health professionals and gay men, including gay men-identified CBO workers, over whether mass HIV testing should target gay men or anyone who engaged in sexual risk behaviors. This study argued that a particular focus on gay men due to pursuing biomedical advances in HIV/AIDS prevention seems to have unintendedly stereotyped gay men based on the presumptions that they are at risk of developing HIV/AIDS. In addition, this study corresponded to the broader social scientific discussion concerning whether HIV/AIDS intervention should target specific sexual risk practices or sexual identity/population.
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Affiliation(s)
- Lei Yang
- School of Public Administration, Beihang University, Beijing, P.R. China
| | - Zhipeng Sun
- Shanghai Technician School; Higher Vocational and Technical College, Shanghai University of Engineering Science, Shanghai, P.R. China
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Witzel TC, Nicholls EJ, McCabe L, Weatherburn P, McCormack S, Bonell C, Gafos M, Lampe FC, Speakman A, Dunn D, Ward D, Phillips AN, Pebody R, Gabriel MM, Collaco-Moraes Y, Rodger AJ, Burns FM. Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study. Sex Transm Infect 2023; 99:534-540. [PMID: 37607814 PMCID: PMC10715485 DOI: 10.1136/sextrans-2023-055840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIV Self-testing Public Health Intervention), the largest randomised trial of HIVST in a high-income country to date. METHODS 10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively. RESULTS Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did. DISCUSSION HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up. TRIAL REGISTRATION NUMBER ISRCTN20312003.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Weatherburn
- Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Christopher Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mitzy Gafos
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Michelle M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
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Freitas CAM, Rossi TA, Dourado I, Castellanos MEP, Guimarães NS, Magno L. Mapping evidence on health promotion in HIV testing among men who have sex with men and transgender women using the social-ecological model and the vulnerability theoretical framework: a scoping review. BMC Public Health 2023; 23:1946. [PMID: 37805484 PMCID: PMC10559455 DOI: 10.1186/s12889-023-16860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
This study aimed to map the scientific evidence on health promotion in human immunodeficiency virus) HIV testing among men who have sex with men (MSM) and transgender women (TGW) based on the social-ecological model (i.e., individual, organizational and social levels) and the theoretical framework of vulnerability (i.e., individual, social, and programmatic levels). The reviewed studies indicated several barriers to accessing HIV testing (e.g., economic, structural, and bureaucratic) and demonstrated the potential for community approaches to promote greater access to HIV testing and minimize the stigma and discrimination associated with HIV testing, primarily through community leadership and social support networks. The socio-ecological model of health promotion and the vulnerability approach have the potential to contribute to improving HIV testing services by balancing the technical and political power of health services and providers with community participation while considering the social contexts. Therefore, there is a need for reflection on health promotion policies and programs aimed at expanding access to HIV testing among MSM and TGW through interventions that consider the social contexts and cultural perspectives. Moreover, inter-sectoral strategies aimed at improving living conditions and access to fundamental resources for maintaining health and well-being should be considered.
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Affiliation(s)
- Camila Amaral Moreno Freitas
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil.
| | - Thais Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
| | | | - Nathalia Sernizon Guimarães
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Basílio da Gama Street, Salvador, BA, 40110-040, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), 2555 Silveira Martins Street, Salvador, BA, 41150000, Brazil
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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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Zhao P, Shi Y, Wang C. Coerced syphilis self-testing among men who have sex with men: a nationwide cross-sectional study in China. BMC Infect Dis 2022; 22:485. [PMID: 35606752 PMCID: PMC9125904 DOI: 10.1186/s12879-022-07476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Syphilis testing uptake remains low among men who have sex with men (MSM) in many low-and middle-income countries. Syphilis self-testing is an efficacious approach on increasing syphilis testing coverage. However, one unintended consequence is the syphilis self-testing coercion from others (including partners, healthcare providers, friends, etc.). This study aimed to examine the prevalence, pattern and correlates of coerced syphilis self-testing among MSM in China. METHODS A nationwide online cross-sectional study was conducted from 14 to 28 July 2018. Sociodemographic characteristics, sexual behaviors and coerced syphilis self-testing variables were collected through a questionnaire that targeted MSM in China. Multivariable logistic regression was used to explore associated factors with syphilis self-testing coercion. RESULTS Overall, 174 MSM were recruited in this study, 31 men (17.8%) reported ever experiencing syphilis self-testing coercion. The most common types of coercion before syphilis self-testing were verbal abuse (38.7%, 12/31) and threatening to end a relationship (38.7%, 12/31). After obtaining the self-test results, men were mostly subjected to end a relationship (45.2%, 14/31) and threaten of violence (35.5%, 11/31). Multivariable logistic regression indicated that men who used condoms inconsistently in the past three months, ever used substances before or during sex, ever had group sex with males and commercial sex were more likely to experience syphilis self-testing coercion. CONCLUSIONS Coerced syphilis self-testing was prevalent among MSM in China. Innovative intervention to reduce coerced syphilis self-testing is necessary among MSM in China.
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Affiliation(s)
- Peizhen Zhao
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, 510095 China
- STD Control Department, Southern Medical University Institute for Global Health, Guangzhou, China
| | - Yijia Shi
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Cheng Wang
- STD Control Department, Dermatology Hospital, Southern Medical University, Guangzhou, 510095 China
- STD Control Department, Southern Medical University Institute for Global Health, Guangzhou, China
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Wang C, Li X, Wang Y, Yang B. Syphilis Self-Testing Among Female Sex Workers in China: Implications for Expanding Syphilis Screening. Front Public Health 2022; 10:744240. [PMID: 35493357 PMCID: PMC9045586 DOI: 10.3389/fpubh.2022.744240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSyphilis self-testing (SST) may help expand syphilis test uptake among female sex workers. However, there has been no studies on examining SST among female sex workers. We aim to examine SST experience and its determinants among female sex workers in China.MethodsA venue-based, cross-sectional study of female sex workers was conducted in eight Chinese cities in 2019. Participants completed a survey including socio-demographic characteristics, sexual behaviors, and SST history. Multivariable logistic regression was conducted to evaluate the associated factors with SST.ResultsAmong 1,287 Chinese female sex workers, 72.1% (928/1,287) had ever tested for syphilis, and 5.9% (76/1,287) had ever used syphilis self-testing. Among syphilis self-testers, more than half (57.9%, 44/76) reported that the self-test was their first syphilis test, around one-fifth (18.4%, 14/76) reported that syphilis self-testing results influenced the price of commercial sex. After adjusting for covariates, female sex workers who received anal sex in the past month (adjusted odds ratio [aOR]: 2.6, 95%CI: 1.5–4.3, p < 0.001), used drugs before or during sex (aOR: 3.8, 95%CI: 2.3–6.4, p < 0.001), tested for other sexually transmitted infections (STIs) in the past 6 months (aOR: 3.4, 95%CI: 1.9–6.0), ever tested in the hospital (aOR: 5.1, 95%CI: 2.5–10.4, p < 0.001), and ever tested in the community (aOR: 1.7, 95%CI: 1.3–2.2, p < 0.001) were more likely to perform syphilis self-testing.ConclusionsSyphilis self-testing has the potential to expand testing coverage, and increase testing frequency with limited potential harms among FSW. Further evaluation on the intervention effects based on syphilis self-testing among FSW are needed.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
- *Correspondence: Cheng Wang
| | - Xia Li
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Yajie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, China
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Pressure to Use HIV Self-Tests Among Men Who Have Sex With Men, United States, 2015-2016. AIDS Behav 2022; 26:623-630. [PMID: 34406551 DOI: 10.1007/s10461-021-03422-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
To assess whether pressuring others to use HIV self-tests is prevalent among US men who have sex with men (MSM), we analyzed data from a randomized controlled trial of HIV self-testing. Among 752 online-recruited MSM who received HIV self-tests and responded to a 12-month survey, 8.5% (60/709) reported pressuring someone to use an HIV self-test: 29 pressured a friend, 28 pressured a sexual partner, and 1 pressured a family member. Conversely, 2.1% (15/715) reported being pressured to self-test: 12 by a sexual partner and 3 by a friend. No physical harm was reported. HIV prevention programs that use HIV self-tests to reach populations at risk for HIV may be reassured by our findings because, despite reports of pressure to use HIV self-tests, no physical abuse was reported between sex partners. These programs should, however, include messages emphasizing the voluntary use of HIV self-tests and be prepared to address concerns of persons who have been pressured to use HIV self-tests. This trial is registered at www.clinicaltrials.gov (NCT02067039) and the date of registration is February 5, 2014.
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Yang X, Jiang L, Fang T, Huang J, Tan S, Lu C, Zhu J, Huang H, Wang M, Zhang Y, Liang H, Cen P, Ning C. Individual and network factors associated with HIV self-testing among men who have sex with men in resource-limited settings in China. Sex Health 2022; 19:212-223. [DOI: 10.1071/sh21133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/17/2022] [Indexed: 11/23/2022]
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Rivera AS, Hernandez R, Mag-Usara R, Sy KN, Ulitin AR, O'Dwyer LC, McHugh MC, Jordan N, Hirschhorn LR. Implementation outcomes of HIV self-testing in low- and middle- income countries: A scoping review. PLoS One 2021; 16:e0250434. [PMID: 33939722 PMCID: PMC8092786 DOI: 10.1371/journal.pone.0250434] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION HIV self-testing (HIV-ST) is an effective means of improving HIV testing rates. Low- and middle-income countries (LMIC) are taking steps to include HIV-ST into their national HIV/AIDS programs but very few reviews have focused on implementation in LMIC. We performed a scoping review to describe and synthesize existing literature on implementation outcomes of HIV-ST in LMIC. METHODS We conducted a systematic search of Medline, Embase, Global Health, Web of Science, and Scopus, supplemented by searches in HIVST.org and other grey literature databases (done 23 September 2020) and included articles if they reported at least one of the following eight implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, or sustainability. Both quantitative and qualitative results were extracted and synthesized in a narrative manner. RESULTS AND DISCUSSION Most (75%) of the 206 included articles focused on implementation in Africa. HIV-ST was found to be acceptable and appropriate, perceived to be convenient and better at maintaining confidentiality than standard testing. The lack of counselling and linkage to care, however, was concerning to stakeholders. Peer and online distribution were found to be effective in improving adoption. The high occurrence of user errors was a common feasibility issue reported by studies, although, diagnostic accuracy remained high. HIV-ST was associated with higher program costs but can still be cost-effective if kit prices remain low and HIV detection improves. Implementation fidelity was not always reported and there were very few studies on, penetration, and sustainability. CONCLUSIONS Evidence supports the acceptability, appropriateness, and feasibility of HIV-ST in the LMIC context. Costs and user error rates are threats to successful implementation. Future research should address equity through measuring penetration and potential barriers to sustainability including distribution, cost, scale-up, and safety.
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Affiliation(s)
- Adovich S Rivera
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ralph Hernandez
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Regiel Mag-Usara
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Karen Nicole Sy
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Allan R Ulitin
- Institute of Health Policy and Development Studies, National Institutes for Health, Manila, Philippines
| | - Linda C O'Dwyer
- Galter Health Sciences Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Megan C McHugh
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Neil Jordan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, United States of America
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Wang C, Cheng W, Li C, Tang W, Ong JJ, Smith MK, Fu H, Marks M, Nie J, Zheng H, Tucker JD, Yang B. Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China. Clin Infect Dis 2021; 70:2178-2186. [PMID: 31260513 DOI: 10.1093/cid/ciz603] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Syphilis self-testing may help expand syphilis testing among men who have sex with men (MSM). China has rapidly scaled up human immunodeficiency virus (HIV) self-testing, creating an opportunity for integrated syphilis self-testing. However, there is a limited literature on implementing syphilis self-testing. METHODS A cross-sectional online survey was conducted among Chinese MSM in 2018. Participants completed a survey instrument including sociodemographic characteristics, sexual behaviors, syphilis self-testing, and HIV self-testing history. Multivariable logistic regression was conducted to identify correlates of syphilis self-testing. We also recorded potential harms associated with syphilis self-testing. RESULTS Six hundred ninety-nine MSM from 89 cities in 21 provinces in China completed the study. A total of 361/699 (51.7%) men tested for syphilis, of whom 174/699 (24.9%) men used syphilis self-testing. Among 174 who had self-tested, 90 (51.7%) reported that the self-test was their first syphilis test and 161 (92.5%) reported that they undertook syphilis self-testing together with HIV self-testing. After adjusting for covariates, syphilis self-testing was correlated with disclosure of sexual orientation to family or friends (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.32-2.73), reporting 2-5 male sexual partners (aOR, 1.81; 95% CI, 1.04-3.16), HIV self-testing (aOR, 39.90; 95% CI, 17.00-93.61), and never tested for syphilis in the hospital (aOR, 2.96; 95% CI, 1.86-4.72). Self-reported harms associated with syphilis self-testing were minimal. CONCLUSIONS Scaling up syphilis self-testing could complement facility-based testing in China among MSM. Self-testing may increase first-time testing and has limited harms. Our findings suggest that syphilis self-testing could be integrated into HIV self-testing services.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Weibin Cheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
| | - Changchang Li
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.,Central Clinical School, Monash University, Melbourne, Australia
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Juan Nie
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China.,University of North Carolina Project-China, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.,Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and Sexually Transmitted Infection Control, Guangzhou, China
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Wang C, Wang YJ, Tucker JD, Xiong MZ, Fu HY, Smith MK, Tang WM, Ong JJ, Zheng HP, Yang B. Correlates of HIV self-testing among female sex workers in China: implications for expanding HIV screening. Infect Dis Poverty 2020; 9:147. [PMID: 33092641 PMCID: PMC7583185 DOI: 10.1186/s40249-020-00765-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) self-testing may help improve test uptake among female sex workers. China has implemented many HIV self-testing programs among men who have sex with men, creating an opportunity for promotion among female sex workers. However, there is a limited literature on examining HIV self-testing among female sex workers. This study aimed to examine HIV self-testing experiences and its determinants among female sex workers in China. Methods A venue-based, cross-sectional study was conducted among Chinese female sex workers in 2019. Participants completed a survey including social-demographic characteristics, sexual behaviors, and HIV self-testing history, the distribution of which were analyzed using descriptive analysis. Multivariable logistic regression was conducted to identify associations with HIV self-testing. Results Among 1287 Chinese female sex workers, 1072 (83.3%, 95% confidence interval [CI] 81.2–85.3%) had ever tested for HIV, and 103 (8.0%, 95% CI 6.6–9.6%) had ever used HIV self-testing. More than half reported that the self-test was their first HIV test (59.2%, 61/103), around one-fifth reported HIV self-testing results influenced the price of sex (21.4%, 22/103). A minority of individuals reported ever experiencing pressure to undertake HIV self-testing (6.8%, 7/103). After adjusting for covariates, HIV self-testing was positively associated with receiving anal sex in the past month (adjusted odds ratio [aOR] = 2.2, 95% CI 1.4–3.5), using drugs before or during sex (aOR = 2.8, 95% CI 1.8–4.5), injecting drugs in the past 6 months (aOR = 2.6, 95% CI 1.2–6.0), being diagnosed with other sexually transmitted infections (aOR = 1.6, 95% CI 1.0–2.5), tested for other sexually transmitted infections in the past six months (aOR = 3.4, 95% CI 2.1–5.5), ever tested in the hospital (aOR = 3.4, 95% CI 2.0–5.6), and ever tested in the community (aOR = 1.5, 95% CI 1.2–1.9). Conclusions Our findings suggest that HIV self-testing could expand overall HIV testing uptake, increase HIV testing frequency, reach sub-groups of high-risk female sex workers and has limited potential harms among female sex workers. HIV self-testing should be incorporated among Chinese female sex workers as a complement to facility-based HIV testing services.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China. .,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.
| | - Ya-Jie Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, Guangdong, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Ming-Zhou Xiong
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Hong-Yun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, USA
| | - Wei-Ming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China.,University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Victoria, Melbourne, Australia
| | - He-Ping Zheng
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Southern Medical University Institute for Global Health and Sexually Transmitted Diseases, Guangzhou, Guangdong, China
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Yan X, Su H, Zhang B, Li Y, Zhang L, Jia Z. Adherence of HIV Self-Testing Among Men Who Have Sex With Men in China: Longitudinal Study. J Med Internet Res 2020; 22:e19627. [PMID: 32940619 PMCID: PMC7530689 DOI: 10.2196/19627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/06/2020] [Accepted: 07/26/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The World Health Organization recommended HIV self-testing (HIVST) for individuals practicing unsafe sexual behaviors; however, the adherence to HIV testing has not been reported. OBJECTIVE In this study, we attempted to determine the adherence to HIVST among men who have sex with men (MSM), as well as the impact factors and potential effects of their adherence. METHODS We conducted a longitudinal study among MSM in Harbin, Heilongjiang province, China from July 1, 2017 to June 30, 2018. A mobile app system was used to provide the "Mailing rapid test reagent kit" for the HIVST service. The proportion of those who adhered to HIV testing every 3 months was calculated. Logistic regression was used to explore the impact factors related to adherence to HIVST. Rates of HIV infection between MSM who adhered to HIVST and those who did not were compared using Cox proportional hazards regression. Changes of condom use behaviors between the two groups were also compared using the chi-square test. RESULTS A total of 1315 MSM who received the HIVST service through the app were included in the study. Overall, 10% of the MSM adhered to HIVST, and the proportion of adhering tests was only 34.9%. Adherence of HIVST was associated with marital status (adjusted odds ratio [OR]unmarried vs married 2.31, 95% CI 1.13-4.71) and the number of HIV tests they received (adjusted OR3 times vs 2 times or below 3.36, 95% CI 2.01-5.63; adjusted OR4 times or above vs 2 times or below 7.30, 95% CI 4.67-11.42). Twenty HIV seroconversions were observed during 1-year follow up. The rate of HIV infection in the adherence group (17.10 per 100 person years, 95% CI 8.80-30.84) was significantly higher than that in the nonadherence group (4.80 per 100 person years, 95% CI 2.77-7.88; adjusted hazard ratio 3.33, 95% CI 1.35-8.20). Those who adhered to HIV testing were more likely to improve condom use behaviors, although the difference was not statistically significant. CONCLUSIONS Regular HIV testing is necessary for early detection of HIV infection among MSM. Given the poor adherence, a new internet-based management paradigm for MSM is needed to raise their health awareness to optimize the implementation of HIVST.
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Affiliation(s)
- Xiangyu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China
| | - Hexuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Bo Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China
| | - Yongjie Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lingling Zhang
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Zhongwei Jia
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China.,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
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Kumwenda MK, Johnson CC, Choko AT, Lora W, Sibande W, Sakala D, Indravudh P, Chilongosi R, Baggaley RC, Nyirenda R, Taegtmeyer M, Hatzold K, Desmond N, Corbett EL. Exploring social harms during distribution of HIV self-testing kits using mixed-methods approaches in Malawi. J Int AIDS Soc 2019; 22 Suppl 1:e25251. [PMID: 30907508 PMCID: PMC6432111 DOI: 10.1002/jia2.25251] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/24/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) provides couples and individuals with a discreet, convenient and empowering testing option. As with all HIV testing, potential harms must be anticipated and mitigated to optimize individual and public health benefits. Here, we describe social harms (SHs) reported during HIVST implementation in Malawi, and propose a framework for grading and responding to harms, according to their severity. METHODS We report findings from six HIVST implementation studies in Malawi (2011 to 2017) that included substudies investigating SH reports. Qualitative methods included focus group discussions, in-depth interviews and critical incident interviews. Earlier studies used intensive quantitative methods (post-test questionnaires for intimate partner violence, household surveys, investigation of all deaths in HIVST communities). Later studies used post-marketing reporting with/without community engagement. Pharmacovigilance methodology (whereby potentially life-threatening/changing events are defined as "serious") was used to grade SH severity, assuming more complete passive reporting for serious events. RESULTS During distribution of 175,683 HIVST kits, predominantly under passive SH reporting, 25 serious SHs were reported from 19 (0.011%) self-testers, including 15 partners in eight couples with newly identified HIV discordancy, and one perinatally infected adolescent. There were no deaths or suicides. Marriage break-up was the most commonly reported serious SH (sixteen individuals; eight couples), particularly among serodiscordant couples. Among new concordant HIV-positive couples, blame and frustration was common but rarely (one episode) led to serious SHs. Among concordant HIV-negative couples, increased trust and stronger relationships were reported. Coercion to test or disclose was generally considered "well-intentioned" within established couples. Women felt empowered and were assertive when offering HIVST test kits to their partners. Some women who persuaded their partner to test, however, did report SHs, including verbal or physical abuse and economic hardship. CONCLUSIONS After more than six years of large-scale HIVST implementation and in-depth investigation of SHs in Malawi, we identified approximately one serious reported SH per 10,000 HIVST kits distributed, predominantly break-up of married serodiscordant couples. Both "active" and "passive" reporting systems identified serious SH events, although with more complete capture by "active" systems. As HIVST is scaled-up, efforts to support and further optimize community-led SH monitoring should be prioritized alongside HIVST distribution.
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Affiliation(s)
- Moses K Kumwenda
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
- Helse Nord TB InitiativeCollege of MedicineUniversity of MalawiBlantyreMalawi
| | - Cheryl C Johnson
- HIV and Global Hepatitis DepartmentWorld Health OrganizationGenevaSwitzerland
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Augustine T Choko
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Wezzie Lora
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Wakumanya Sibande
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
| | - Doreen Sakala
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
| | - Pitchaya Indravudh
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Rachael C Baggaley
- HIV and Global Hepatitis DepartmentWorld Health OrganizationGenevaSwitzerland
| | | | - Miriam Taegtmeyer
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Karin Hatzold
- Population Services InternationalJohannesburgSouth Africa
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Elizabeth L Corbett
- Malawi Liverpool Wellcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene and Tropical MedicineLondonUK
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Reply. J Acquir Immune Defic Syndr 2018; 78:e35. [PMID: 29985302 DOI: 10.1097/qai.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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