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Out of the Closet, Into the Clinic: Opportunities for Expanding Men Who Have Sex With Men–Competent Services in China

Watson, Julia, BA*†‡; Tang, Weiming, PhD*†‡§; Pan, Stephen, PhD†¶; Wu, Dan, PhD*†‡; Zhao, Peipei, MS*†∥; Cao, Bolin, PhD†**; Liu, Chuncheng, BA*†††; Bien, Cedric, MD*†; Huang, Wenting, MS*†; Luo, Zhenzhou, MS; Tucker, Joseph D., MD*†‡‡‡

doi: 10.1097/OLQ.0000000000000808
Original Studies

Background Despite the high human immunodeficiency virus (HIV) burden among men who have sex with men (MSM), there is little research on health services provided to MSM in China and other low- and middle-income countries. Discrimination and inadequate services may discourage MSM from seeking health care services. This study examined essential services provided to MSM and health care discrimination among MSM in China.

Methods A nationwide cross-sectional online survey was conducted among MSM who saw a physician in the last 24 months in China. The survey included items on sociodemographic information, HIV testing, experiences from the last physician encounter, and history of perceived health care discrimination. We defined MSM-competent physicians as physicians who asked their patient about having sex with other men, asked about anal sex, and either asked about or recommended HIV testing at the most recent visit.

Results Among the 503 participants, 35.0% (176/503) saw an MSM-competent physician. In multivariate analyses, respondents who saw an MSM-competent physician were more likely to be younger (adjusted odds ratio [AOR], 0.87; 95% confidence interval [CI], 0.81–0.94), have a primary care physician (AOR, 3.24; 95% CI, 1.85–5.67), and be living with HIV (AOR, 2.01; 95% CI, 1.13–3.56). 61.2% (308/503) of MSM had ever experienced health care discrimination.

Conclusions Our data suggest that there is variability in the extent to which physicians are meeting the needs of MSM in China. There is an urgent need to evaluate and expand MSM-competent services in China.

A study of men who have sex with men (MSM) who saw a physician in the last 2 years in China found that only a small proportion of MSM saw an MSM-competent physician. Men who have sex with men who saw an MSM-competent physician were more likely to be younger, have a primary care physician, and living with human immunodeficiency virus than those who did not. A high proportion of Chinese MSM had ever experienced health care discrimination.

From the *University of North Carolina Project-China;

SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China;

School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;

§Dermatology Hospital of Southern Medical University, Guangzhou;

Xi'an Jiaotong-Liverpool University, Suzhou, China;

Shenzhen Nanshan Center for Chronic Diseases Control;

**College of Mass Communication, Shenzhen University, Shenzhen, China;

††Department of Sociology, University of California, San Diego, La Jolla, CA; and

‡‡Infectious and Tropical Diseases Faculty, London School of Hygiene and Tropical Medicine, London, United Kingdom

Acknowledgments: The authors thank all the study participants and staff members at SESH Global, Danlan, and Shenzhen Nanshan Center for Chronic Disease Control who contributed.

Source of Funding: This work was supported by the National Institutes of Health [National Institute of Allergy hand Infectious Diseases 1R01AI114310]; UNC-South China STD Research Training Centre [Fogarty International Centre 1D43TW009532]; UNC Center for AIDS Research [National Institute of Allergy and Infectious Diseases 5P30AI050410]; and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138).

Conflict of Interest: None declared.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Zhenzhou Luo, MS, Shenzhen Nanshan Center for Chronic Diseases Control, Nanshan Block, Huaming Rd 7, Shenzhen, 518052, China. E-mail:; Joseph D. Tucker, MS, PhD, University of North Carolina Project-China, No. 2, Lujing Rd, Guangzhou, 510095, China. E-mail:

Received for publication October 27, 2017, and accepted February 6, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association