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Predictors of HIV Testing Among Men Who Have Sex With Men in a Large Chinese City

Zhang, Lan MD*†; Xiao, Yan MD, DrPH†‡; Lu, Rongrong MD§; Wu, Guohui MD§; Ding, Xianbin MD, MPH§; Qian, Han-zhu MD, PhD; McFarland, Willi MD, PhD∥#; Ruan, Yuhua PhD; Vermund, Sten H. MD, PhD*‡¶**; Shao, Yiming MD, PhD

Sexually Transmitted Diseases: March 2013 - Volume 40 - Issue 3 - p 235–240
doi: 10.1097/OLQ.0b013e31827ca6b9
Original Study

Background HIV testing is the gateway for prevention and care. We explored factors associated with HIV testing among Chinese men who have sex with men (MSM).

Methods In Chongqing City, we recruited 492 MSM in 2010 using respondent-driven sampling in a cross-sectional study. Computer-assisted self-interviews were conducted to collect information on history of HIV testing.

Results Only 58% of participants reported ever having taken an HIV test. Men who have sex with men who had a college degree (adjusted odds ratio [AOR], 1.7; 95% confidence interval (CI), 1.2–2.6; P = 0.008) were more likely to take a test; those who preferred a receptive role in anal sex were less likely to do so than those with insertive sex preference (AOR, 0.6; 95% CI, 0.35–0.94; P = 0.03); and those who used condoms with the recent male partner during the past 6 months were more likely to get tested (AOR, 2.87; 95% CI, 1.25–6.62; P = 0.01). Principal perceived barriers to testing included the following: fear of knowing a positive result, fear of discrimination if tested positive, low perceived risk of HIV infection, and not knowing where to take a test. Factors reported to facilitate testing were sympathetic attitudes from health staff and guaranteed confidentiality. Prevalence was high: 11.7% HIV positive and 4.7% syphilis positive.

Conclusions The HIV testing rate among MSM in Chongqing is still low, although MSM prevalence is high compared with other Chinese cities. Men who have sex with men preferring receptive anal sex are less likely to get testing and perceive having lower HIV risk. Along with expanded education and social marketing, a welcoming and nonjudgmental environment for HIV testing is needed.

Among Chinese men who have sex with men, those who preferred a receptive role in anal sex and those with less education were less likely to have a history of HIV testing.

From the *Vanderbilt Institute for Global Health, Nashville, TN; †State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China; ‡Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN; §Chongqing Center for Disease Control and Prevention, Chongqing, China; ¶ Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; ∥San Francisco Department of Public Health, San Francisco, CA; #Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; and **Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.

Supported by grants from the National Natural Science Foundation of China (81161120428), the National Institutes of Health (R01AI078933, D43TW001035, and R01AI094562), the Ministry of Science and Technology of China (2012ZX10001-002), and Chinese State Key Laboratory for Infectious Disease Develop Grant (2011SKLID102).

L. Zhang, Y. Xiao, and R. Lu contributed equally to this work.

Conflicts of interests: None.

Correspondence: Sten H. Vermund, MD, PhD, 2525 West End Ave Ste.750, Nashville TN 37203. E-mail:

Received for publication May 11, 2012, and accepted November 5, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association