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Benefits and Potential Harms of Human Immunodeficiency Virus Self-Testing Among Men Who Have Sex With Men in China: An Implementation Perspective

Qin, Yilu BA; Tang, Weiming PhD; Nowacki, Amy PhD; Mollan, Katie MS; Reifeis, Sarah A. BA; Hudgens, Michael G. PhD; Wong, Ngai-Sze PhD; Li, Haochu PhD; Tucker, Joseph D. MD; Wei, Chongyi DrPH

Sexually Transmitted Diseases: April 2017 - Volume 44 - Issue 4 - p 233–238
doi: 10.1097/OLQ.0000000000000581
Original Studies

Background Human immunodeficiency virus self-testing (HIVST) holds great promise for reaching high-risk key populations who do not access facility-based services. We sought to characterize unsupervised HIVST implementation among men who have sex with men in China.

Methods We conducted a nationwide online survey in China. Eligible men were at least 16 years, had anal sex with a man, and had recent condomless sex. We assessed benefits (first-time testing, increased testing frequency, confirmatory testing) and potential harms (coercion, violence, suicidality) of HIVST. Among men who have sex with men who reported ever testing for human immunodeficiency virus (HIV), we identified correlates of HIVST as first-time HIV test being a self-test using multivariable logistic regression.

Results Among 1610 men who met the eligibility criteria and started the survey, 1189 (74%) completed it. Three hundred forty-one (29%) of 1189 reported ever self-testing for HIV. Human immunodeficiency virus prevalence was 7% (24/341) among self-testers and 5% (15/306) among non–self-testers. Two hundred (59%) of 341 men who self-tested reported HIVST as a first-time HIV test. Thirty-one (9%) men experienced coercion with HIVST. Thirty-one (78%) of 40 men with positive HIV self-tests sought confirmation. Multivariable analysis revealed that HIVST as first-time HIV test was associated with younger age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92–0.99), not being “out” (OR, 2.28; 95% CI, 1.60–3.28), not using the internet to meet sex partners (OR, 0.39; 95% CI, 0.22–0.69), and group sex (OR, 1.74; 95% CI, 1.02–2.9).

Conclusions Human immunodeficiency virus self-testing reached high-risk individuals that had never received facility-based testing. Further implementation research is needed to better understand HIVST outside of research programs.

A study of men who have sex with men in China found that human immunodeficiency virus self-testing is common and reaches individuals that have not previously tested.

From the *University of North Carolina Project-China, Guangzhou, China; †Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; ‡Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC; and §Department of Epidemiology and Biostatistics, University of California, San Francisco, CA

Acknowledgements: The authors would like to acknowledge contributions from the following people: Alan Taege for initial feedback during planning and project design, Fengying Liu and Larry Han for background information on HIV self-testing in China, and Bolin Cao and May Thitikarn Chen Tangthanasup for article editing.

Conflicts of Interest: None declared.

Sources of Support: Funding for this work was supported by the National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532-01), UNC Center for AIDS Research (NIAID 5P30AI050410-13), UCSF Center for AIDS Research (NIAID P30 AI027763), UJMT Fogarty Fellowship (FIC R25TW0093), Fulbright-Fogarty Fellowship in Public Health, and SESH Global ( The funding source had no role in the design of the study and will not have any role during its execution, analyses, interpretation of data, or decision to submit results.

Correspondence: Chongyi Wei, DrPH, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA 94158. E-mail:

Received for publication July 20, 2016, and accepted December 16, 2016.

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