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Liang Z, Huang YT. Intersecting Stigma and HIV/AIDS Community Participation Among Young Chinese Men Who Have Sex with Men Living with HIV. AIDS Patient Care STDS 2022; 36:73-82. [PMID: 35049339 DOI: 10.1089/apc.2021.0201] [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] [Indexed: 11/12/2022] Open
Abstract
Community participation is vital for the recovery and empowerment of men who have sex with men (MSM) living with HIV. Intersectionality also provides an important lens that inequalities operate in an intersectional manner and pose compound challenges to the lives of minority individuals. However, the association between intersecting stigma toward HIV-positive MSM and their community participation is underexplored. The study drew on a sample of young Chinese MSM living with HIV from a community-based online survey that recruited respondents using nonprobability purposive sampling (n = 1004). Structural equation modeling was performed to investigate the associations among perceived stigma against sexual minorities and people living with HIV, HIV-related self-stigma, and HIV/AIDS community participation. The indirect effect of self-stigma and the statistical interaction between perceived homosexual stigma and perceived HIV-related stigma were further examined. Results show that total direct effect was significant [B (SE) = 0.859 (0.233); confidence interval (95% CI) = 0.402-1.316]. Perceived HIV-related stigma was positively correlated with HIV/AIDS community participation, while HIV-related self-stigma was negatively correlated. The mediating role of HIV-related self-stigma was significant in both types of perceived stigma [total indirect effect: B (SE) = -0.935 (0.175); 95% CI = -1.277 to -0.593]. The interaction effect was also significant and negative [B (SE) = -0.117 (0.056), p < 0.001], showing that perceived homosexual stigma could offset the effect of perceived HIV-related stigma on HIV-related self-stigma. The findings illustrate how intersecting stigma is involved in HIV-related self-stigma and community participation and highlight the importance of applying an intersectionality perspective to investigate stigma toward MSM living with HIV and their community participation.
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Affiliation(s)
- Zurong Liang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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2
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Cao W, You X, Li J, Peng L, Gu J, Hao C, Hou F, Wei D, Deng Y, Hao Y, Mo PKH. Same-sex behavior disclosure to health care providers associated with greater awareness of pre-exposure prophylaxis. BMC Public Health 2021; 21:2243. [PMID: 34893061 PMCID: PMC8665488 DOI: 10.1186/s12889-021-12317-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study aimed to determine whether the disclosure of same-sex behavior to health care providers (HCPs) is associated with higher rates of prior human immunodeficiency virus (HIV) testing experience and greater awareness of immediate antiretroviral therapy (ART), Undetectable = Untransmittable (U=U), and pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM). METHODS We conducted a cross-sectional survey among 689 adult males in Chengdu, China who self-reported having had anal intercourse with at least one man in the past 6 months. We measured same-sex behavior disclosure to three types of HCPs (hospital clinicians, community-based organization peer educators, and Center for Disease Control and Prevention public health specialists), and the awareness of immediate ART, U=U, and PrEP. RESULTS Of the 689 enrolled participants, 31.4% had disclosed their same-sex behavior to some or all of the clinicians, 83.9% had done so to the peer educators, and 56.8% had done so to the public health specialists. Approximately four in five (82.1%) of the participants had ever been tested for HIV. The awareness rate was 84.8% for immediate ART, 20.2% for U=U, and 50.7% for PrEP. After controlling for significant background variables, same-sex behavior disclosure to clinicians was associated with greater awareness of PrEP (adjusted odds ratio [AOR] = 1.64; 95% confidence interval [CI]: 1.08-2.48), but similar findings were not reported regarding disclosure to peer educators or public health specialist. Same-sex behavior disclosure to any types of HCPs was not associated with HIV testing experience, and awareness of immediate ART or U=U. CONCLUSIONS The rates of same-sex behavior disclosure varied with different types of HCPs. Disclosure to clinicians was associated with greater awareness of PrEP, but not awareness of immediate ART or U=U.
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Affiliation(s)
- Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinyi You
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Liping Peng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Fengsu Hou
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.,Department of Public Mental Health, Kangning Hospital, Shenzhen, Guangdong, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yang Deng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Phoenix Kit-Han Mo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing St, Shatin, Hong Kong.
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3
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Mental Health Services for Men Who Have Sex with Men in China. Community Ment Health J 2021; 57:380-386. [PMID: 32594327 PMCID: PMC7765735 DOI: 10.1007/s10597-020-00660-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
This study explores the presence of mental health challenges and related service utilization among MSM in China. An online cross-sectional survey recruited 520 MSM in Guangdong, China, to evaluate the participants' psychiatric symptoms, service fulfillment, and challenges. A high proportion of the participants experienced at least one psychiatric symptom in the past year, but less than half of their mental health service needs were fulfilled. The preferred agencies for mental health services were provincial and city-level general hospitals or primary health centers. Lack of knowledge and misconceptions of mental health services were the primary reasons for not receiving necessary services. Mental health service fulfillment was associated with younger age, lower education, higher income, local residency, cohabitation, and disclosure of MSM status. The high rate of mental health issues and gaps in service seeking indicates an urgent need to increase mental health awareness among MSM.
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4
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Liu L, Wang D, Qin X, Hu Z, Chen R. The impact of social capital on civil society organizations delivering voluntary counseling and testing HIV/AIDS service: a cross-sectional study in China. Biosci Trends 2020; 14:182-191. [PMID: 32418946 DOI: 10.5582/bst.2020.03110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In China, Voluntary HIV Counseling and Testing (VCT) services are mostly provided by Civil Society Organizations (CSOs). This cross-sectional study investigated the association between CSOs' social capital and VCT service availability in eight Chinese provinces during July-December 2015. Data on CSOs' characteristics were collected through questionnaire-based interviews. Social capital was measured using a purpose-developed questionnaire. Logistic regression models tested the association between social capital and the scale of VCT services. A total of 103 CSOs that provided VCT to MSM (MSM-focused CSOs), and 109 CSOs that provided such service to non-MSM population (other CSOs) were included. Overall, 144 (67.9%) CSOs were not registered with local governments, while 106 (50%) received RMB 50,000 ($7,670) funding in 2014. Multivariate logistic regression analysis indicated that the CSOs with a higher level of shared vision were more likely to provide a large-scale of VCT service than those with a lower level of shared vision (AOR = 1.95). Moreover, intra-networks were positively associated with the VCT service (AOR = 2.87) among other CSOs, while the level of shared vision was positively associated with the VCT service (AOR = 3.08) among other-MSM-focused CSOs. There was no significant association between social capital and total service scale. Our findings suggest that increasing social capital can potentially enhance VCT service and play an important role in AIDS prevention.
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Affiliation(s)
- Liu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Danni Wang
- Central Laboratory of Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xia Qin
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Zhi Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Ren Chen
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
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5
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Li C, Barrington C, Jiang H, Lei G, Golin CE, Fisher EB, Muessig KE. Challenges for accessing and maintaining good quality of HIV care among men who have sex with men living with HIV in China: a qualitative study with key stakeholders. AIDS Care 2020; 32:119-126. [PMID: 32151139 DOI: 10.1080/09540121.2020.1739210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
HIV care in China is shifting toward a community-based model involving a wide range of stakeholders. We aimed to understand key stakeholders' perceived challenges of providing high-quality care for men who have sex with men (MSM) living with HIV. In-depth interviews were conducted with a diverse sample of stakeholders (N = 17) in two Chinese cities, including providers, policymakers, and community workers. Interviews focused on stakeholders' challenges in HIV-related work and perceived barriers for MSM in accessing and maintaining HIV care. Thematic analysis strategies were used. Three cross-cutting themes related to accessibility and quality of care (QoC) emerged. First, MSM- and HIV-related stigma were perceived to increase the risk of MSM dropping out of care. While acknowledging stigma, some providers also expressed discriminatory views such as stereotypes of the MSM community. Second, stakeholders expressed concerns about QoC including healthcare workforce shortages, limited training opportunities, and high work stress while facing increasingly unmet needs from clients. Third, stakeholders shared challenges in mobilizing community resources to expand HIV care including unclear division of responsibility and strict auditing. Supportive policies and resources may be needed to bolster China's primary care workforce and MSM-competent care and, more broadly, high QoC for sexual and gender minority patients.
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Affiliation(s)
- Chunyan Li
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sciences, Chengdu, People's Republic of China.,School of Medicine, University of Electronic Science and Technology, Chengdu, People's Republic of China
| | - Gang Lei
- Aibai Culture and Education Center, Chengdu, People's Republic of China
| | - Carol E Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Fu R, Kutner BA, Wu Y, Xie L, Meng S, Hou J, Gu Y, Xu H, Zheng H, He N, Meyers K. Do gay and bisexual men who conceal their same-sex behavior prefer different kinds of health services? Findings across four cities to inform client-centered HIV prevention in China. BMC Public Health 2020; 20:4. [PMID: 31906905 PMCID: PMC6945626 DOI: 10.1186/s12889-019-7990-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/21/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In China, addressing disparities in the HIV epidemic among men who have sex with men (MSM) requires targeted efforts to increase their engagement and retention in prevention. In an effort to advance MSM-friendly HIV services within China, and informed by community-based partnerships, we tested whether MSM who have ever versus never disclosed their same-sex behavior to healthcare providers (HCP) differ in sociodemographic and behavioral characteristics as well as the qualities of sexual health services each group would prefer to access. METHODS We conducted a cross-sectional survey among HIV-negative MSM who went to MSM-focused voluntary counseling and testing clinics in four cities in China. The survey was anonymous and collected information on sociodemographic characteristics, testing behaviors, sexual-health related behavior, and sexual health service model preferences. RESULTS Of 357 respondents, 68.1% participants had ever disclosed same-sex behavior to HCPs when seeking advice for sexual health. Younger age (aOR = 1.04; 95% CI: 1.01-1.08), and worry of HIV acquisition (aOR = 1.39; 95% CI: 1.05-1.84) were associated with higher odds of past disclosure. The availability of comprehensive sexual health services was one of the most valued characteristics of the ideal sexual health clinic. Those who ever disclosed and never disclosed differed significantly in their ranking of the importance of three out of ten dimensions: sexual health counseling services available (M = 3.99 vs. M = 3.65, p = .002), gay identity support available (M = 3.91 vs. M = 3.62, p = .016) and clinic collaborates with a gay CBO (M = 3.81 vs. M = 3.56, p = .036). CONCLUSIONS Our hypothesis that MSM who had disclosed versus never disclosed same-sex behavior would differ in the value they placed on different dimensions of sexual health service was partially borne out. As health authorities in China decide on implementation models for pre-exposure prophylaxis (PrEP) delivery and specifically within which institutions to integrate PrEP services, the preferences of target populations should be considered to develop comprehensive, patient-centric and LGBT-friendly services.
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Affiliation(s)
- Rong Fu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Bryan A. Kutner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, 455 1st Avenue, 7th Floor, New York, NY 10016 USA
| | - Lu Xie
- Institution of HIV/AIDS, The First Hospital of Changsha, Changsha, China
| | - Siyan Meng
- School of Public Health, Fudan University, Shanghai, China
| | - Jianhua Hou
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuzhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | | | - Na He
- School of Public Health, Fudan University, Shanghai, China
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, 455 1st Avenue, 7th Floor, New York, NY 10016 USA
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7
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Pan SW, Carpiano RM, Smith MK, Ong JJ, Fu H, Huang W, Tang W, Tucker JD. Supernatural explanatory models of health and illness and healthcare use in China among men who have sex with men. Glob Public Health 2020; 15:83-96. [PMID: 31378138 PMCID: PMC6934899 DOI: 10.1080/17441692.2019.1649445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
People's beliefs in supernatural explanatory models of health and illness - beliefs in divine and/or supernatural forces to inform how they perceive, interpret, and respond to health and illness - may have important implications for their use of healthcare services, especially among individuals with lower socioeconomic status (SES). However, the relevance of such research for contexts with strong Confucian and Buddhist traditions and sexual minority subpopulations remains unclear. We conducted a nation-wide survey in China of 503 men who have sex with men (MSM) to test hypotheses examining how supernatural beliefs impact commitment to a primary healthcare provider and testing history for HIV and syphilis. We also tested hypotheses regarding how SES may moderate such effects. Results indicate that strength of supernatural beliefs is associated with less commitment to a primary care provider and lower likelihood of HIV testing, particularly among men with lower educational attainment. However, among men with low income, supernatural belief was associated with higher likelihood of testing for HIV and syphilis. Belief in supernatural explanatory models of health and illness may have substantial influence on healthcare use among MSM in China. As religion and spirituality evolves within China, additional research concerning supernatural beliefs and healthcare use is warranted.
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Affiliation(s)
- Stephen W Pan
- Department of Health and Environmental Sciences, Xi’an Jiaotong-Liverpool University, Suzhou, China
- UNC-Project China, Guangzhou, China
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, CA, USA
- Department of Sociology, University of California, Riverside, CA, USA
- Center for Healthy Communities, University of California, Riverside, CA, USA
| | - M. Kumi Smith
- UNC-Project China, Guangzhou, China
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jason J Ong
- UNC-Project China, Guangzhou, China
- Central Clinical School, Monash University, Clayton, Victoria, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Wenting Huang
- UNC-Project China, Guangzhou, China
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Weiming Tang
- UNC-Project China, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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8
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Yang X, Wang Z, Harrison S, Lau JTF. Coverage and adherence of antiretroviral therapy among Chinese HIV-positive men who have sex with men with high CD4 counts in the era of 'Treat all'. Trop Med Int Health 2019; 25:308-318. [PMID: 31758830 DOI: 10.1111/tmi.13353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES HIV-positive men who have sex with men (MSM) with CD4 cell counts> 350 cells/mm3 in China recently became eligible for free antiretroviral therapy (ART) due to updated national guidelines. This study aimed to investigate ART coverage and adherence among a large sample of HIV-positive MSM in China. METHODS A cross-sectional survey was conducted in Chengdu and Hangzhou, China, from February to November 2016. Participants were 277 MSM who had received a confirmatory HIV diagnosis and had CD4 levels of> 350 cells/mm3 . Trained staff of collaborating non-governmental organizations contacted all HIV-positive MSM listed in their service records and invited them to join the study. The ART initiation, ART adherence and interactions between healthcare professionals and the patients were assessed. RESULTS ART coverage was 60.3%. Among those who were on ART (n = 167), no participants reported missing any doses in the last four days, but 25.7% reported non-compliance to either ART dosing schedule or dosage instructions. After adjusting for background variables and perceived eligibility for ART, two variables were significant factors of higher ART coverage: (i) receiving a recommendation from healthcare professionals for immediate ART initiation and (ii) perceiving having received an adequate explanation of potential harms of ART. Being prescribed> 3 pills per dose and not having a temporary resident permit were associated with non-compliance. CONCLUSIONS Significant efforts are needed to increase ART coverage among HIV-positive MSM with high CD4 counts in China. Although prevalence of missing doses was low, non-compliance to dosing schedule/instructions should not be neglected. Interactions between healthcare professionals and MSMs play an important role in facilitating ART initiation.
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Affiliation(s)
- Xueying Yang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Sayward Harrison
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Wu D, Huang W, Zhao P, Li C, Cao B, Wang Y, Stoneking S, Tang W, Luo Z, Wei C, Tucker J. A Crowdsourced Physician Finder Prototype Platform for Men Who Have Sex with Men in China: Qualitative Study of Acceptability and Feasibility. JMIR Public Health Surveill 2019; 5:e13027. [PMID: 31596245 PMCID: PMC6913768 DOI: 10.2196/13027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/22/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022] Open
Abstract
Background Men who have sex with men (MSM), including both gay and bisexual men, have a high prevalence of HIV and sexually transmitted infections (STIs) in China. However, healthcare seeking behaviors and engagement in clinical services among MSM are often suboptimal. Global evidence shows that embedding online HIV or sexual health services into gay social networking applications holds promise for facilitating higher rates of healthcare utilization among MSM. We developed a prototype of a gay-friendly health services platform, designed for integration within a popular gay social networking app (Blued) in China. Objective The purpose of this study was to evaluate the acceptability of the platform and ask for user feedback through focus group interviews with young MSM in Guangzhou and Shenzhen, cities in Southern China. Methods The prototype was developed through an open, national crowdsourcing contest. Open crowdsourcing contests solicit community input on a topic in order to identify potential improvements and implement creative solutions. The prototype included a local, gay-friendly, STI physician finder tool and online psychological consulting services. Semistructured focus group discussions were conducted with MSM to ask for their feedback on the platform, and a short survey was administered following discussions. Thematic analysis was used to analyze the data in NVivo, and we developed a codebook based on the first interview. Double coding was conducted, and discrepancies were discussed with a third individual until consensus was reached. We then carried out descriptive analysis of the survey data. Results A total of 34 participants attended four focus group discussions. The mean age was 27.3 years old (SD 4.6). A total of 32 (94%) participants obtained at least university education, and 29 (85%) men had seen a doctor at least once before. Our survey results showed that 24 (71%) participants had interest in using the online health services platform and 25 (74%) thought that the system was easy to use. Qualitative data also revealed that there was a high demand for gay-friendly healthcare services which could help with care seeking. Men felt that the platform could bridge gaps in the existing HIV or STI service delivery system, specifically by identifying local gay-friendly physicians and counselors, providing access to online physician consultation and psychological counseling services, creating space for peer support, and distributing pre-exposure prophylaxis and sexual health education. Conclusions Crowdsourcing can help develop a community-centered online platform linking MSM to local gay-friendly HIV or STI services. Further research on developing social media–based platforms for MSM and evaluating the effectiveness of such platforms may be useful for improving sexual health outcomes.
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Affiliation(s)
- Dan Wu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Wenting Huang
- School of Public Health, Emory University, Atlanta, GA, United States
| | - Peipei Zhao
- Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Shenzhen Nanshan Canter for Chronic Disease Control, Shenzhen, China
| | - Chunyan Li
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Yifan Wang
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Shelby Stoneking
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Weiming Tang
- Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Project-China, University North Carolina at Chapel Hill, Guangzhou, China.,Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Canter for Chronic Disease Control, Shenzhen, China
| | - Chongyi Wei
- Department of Social and Behavior Health Sciences, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Joseph Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Project-China, University North Carolina at Chapel Hill, Guangzhou, China
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10
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Pan SW, Durvasula M, Ong JJ, Liu C, Tang W, Fu H, Wei C, Wang C, Terris-Prestholt F, Tucker JD. No Place Like Home? Disentangling Preferences for HIV Testing Locations and Services Among Men Who Have Sex with Men in China. AIDS Behav 2019; 23:847-859. [PMID: 30565095 PMCID: PMC6458980 DOI: 10.1007/s10461-018-2366-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In China, some health departments and gay community-based organizations have begun to offer home-based HIV testing kits in order to augment test uptake among men who have sex with men (MSM). However, HIV test preferences and motivations for home-testing among MSM in China are not well understood. The HIV testing preferences of 803 MSM throughout China were evaluated using single-item assessment and a discrete choice experiment (DCE). In both the single-item assessment and DCE, participants expressed strong preference for free and anonymous testing by health professionals. Both approaches also indicated that naïve testers most prefer home testing. However, among previous testers, the single-item assessment indicated that "home" was the most preferred testing location (vs. hospital or clinic), while the DCE indicated that "home" was the least preferred testing location after controlling for anonymity. HIV home-testing may have limited appeal to previously tested Chinese MSM if anonymity is not maintained.
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Affiliation(s)
- Stephen W Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, 111 Ren'ai Road, Suzhou Dushu Lake Higher Education Town, Suzhou, 215123, Jiangsu Province, China.
- UNC-Project China, Guangzhou, China.
| | - Maya Durvasula
- Department of Economics, Duke University, Durham, NC, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Chuncheng Liu
- UNC-Project China, Guangzhou, China
- Department of Sociology, University of California at San Diego, San Diego, CA, USA
| | - Weiming Tang
- UNC-Project China, Guangzhou, China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Chongyi Wei
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Identifying MSM-competent physicians in China: a national online cross-sectional survey among physicians who see male HIV/STI patients. BMC Health Serv Res 2018; 18:964. [PMID: 30545370 PMCID: PMC6293610 DOI: 10.1186/s12913-018-3781-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/29/2018] [Indexed: 11/12/2022] Open
Abstract
Background Men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) infection and sexually transmitted infection (STI) in China. Inadequate clinical services and poor clinical competency among physicians are major barriers to improving the sexual health of MSM. This study aims to understand physician clinical competency in providing MSM health services in China. Methods We conducted an online cross-sectional survey among Chinese physicians who have seen male patients for STI complaints in the past year. We obtained information on individual demographics, clinical practice, attitudes toward MSM, and interest in contributing to MSM clinical services. We defined an MSM-competent physician as one who asked male patients about sexual orientation, sexual practices, and recommended HIV/ STI testing during a clinic visit. We conducted multivariable logistic regression to identify factors associated with MSM competency. Results In total, 501 physicians completed the survey. The most common subspecialties were dermatovenereology (33.1%), urology (30.1%), and general medicine (14.4%). Roughly half (n = 267, 53.3%) reported seeing MSM in the past 12 months. Among physicians who saw MSM in the past 12 months, 60.3% (n = 161) met criteria as MSM-competent physicians, and most (n = 234, 87.6%) MSM-competent physicians reported positive or neutral attitudes towards MSM. Over 60% of all physicians were willing to participate in activities for improving MSM services, such as training and being on a list of physicians willing to serve MSM. MSM-competent physicians showed no sociodemographic differences compared with non MSM-competent physicians. MSM-competent physicians were more willing to have their medical institution named on a public clinic list capable of serving MSM (aOR: 1.70, 95%CI: 1.01–2.86) and being on a public physician list capable of serving MSM (aOR: 1.77, 95%CI: 1.03–3.03). Conclusions MSM-competent physicians included a broad range of individuals that practiced in diverse clinical settings. Most physicians were interested in improving and expanding MSM clinical services, despite having neutral attitudes toward same-sex behavior. Future interventions should focus on developing MSM clinical competency and expanding services that meet the needs of MSM.
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Fitzpatrick T, Zhou K, Cheng Y, Chan PL, Cui F, Tang W, Mollan KR, Guo W, Tucker JD. A crowdsourced intervention to promote hepatitis B and C testing among men who have sex with men in China: study protocol for a nationwide online randomized controlled trial. BMC Infect Dis 2018; 18:489. [PMID: 30268114 PMCID: PMC6162889 DOI: 10.1186/s12879-018-3403-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/20/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The World Health Organization recommends all men who have sex with men (MSM) receive Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) testing. MSM in China are a high-risk group for HBV and HCV infection, but test uptake is low. Crowdsourcing invites a large group to solve a problem and then shares the solution with the public. This nationwide online randomized controlled trial will evaluate the effectiveness of a crowdsourced intervention to increase HBV and HCV testing among MSM in China. METHODS Seven hundred MSM will be recruited through social media operated by MSM organizations in China. Eligible participants will be born biologically male, age 16 years or older, report previous anal sex with another man, and reside in China. After completing a baseline online survey, participants will be randomly assigned to intervention or control arms with a 1:1 allocation ratio. The intervention will include two components: (1) a multimedia component will deliver two videos and two images promoting HBV and HCV testing developed through a crowdsourcing contest in China; (2) a participatory component will invite men to submit suggestions for how to improve crowdsourced videos and images. The control arm will not view any images or videos and will not be invited to submit suggestions. All participants will be offered reimbursement for HBV and HCV testing costs. The primary outcome is HBV and HCV test uptake confirmed through electronic submission of test report photos within four weeks of enrolment. Secondary outcomes include self-reported HBV and HCV test uptake, HBV vaccination uptake, and change in stigma toward people living with HBV after four weeks. Primary and secondary outcomes will be calculated using intention to treat and as-exposed analyses and compared using two-sided 95% confidence intervals. DISCUSSION Few previous studies have evaluated interventions to increase HBV and HCV testing in middle-income countries with a high burden of hepatitis. Delivering a crowdsourced intervention using social media is a novel approach to increasing hepatitis testing rates. HBV and HCV test uptake will be confirmed through test report photos, avoiding the limitations of self-reported testing outcomes. TRIAL REGISTRATION NCT03482388 (29 March 2018).
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Affiliation(s)
| | - Kali Zhou
- Department of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, USA
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Po-Lin Chan
- Division of Communicable Disease, World Health Organization Western Pacific Regional Office, Manila, Philippines
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology, Peking University, Beijing, China
| | - Weiming Tang
- UNC - Project China, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katie R Mollan
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wilson Guo
- Gillings School of Global Public Health - Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- UNC - Project China, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Cao B, Zhao P, Bien C, Pan S, Tang W, Watson J, Mi G, Ding Y, Luo Z, Tucker JD. Linking young men who have sex with men (YMSM) to STI physicians: a nationwide cross-sectional survey in China. BMC Infect Dis 2018. [PMID: 29776395 DOI: 10.1186/s12879-018-3145-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many young men who have sex with men (YMSM) are reluctant to seek health services and trust local physicians. Online information seeking may encourage YMSM to identify and see trustworthy physicians, obtain sexual health services, and obtain testing for sexually transmitted infections (STIs). This study examined online STI information seeking behaviors among Chinese YMSM and its association with offline physician visits. METHODS We conducted a nationwide online survey among YMSM through WeChat, the largest social media platform in China. We collected information on individual demographics, sexual behaviors, online STI information seeking, offline STI testing, and STI physician visits. We examined the most commonly used platforms (search engines, governmental websites, counseling websites, generic social media, gay mobile apps, and mobile medical apps) and their trustworthiness. We assessed interest and willingness to use an MSM-friendly physician finder function embedded within a gay mobile app. Logistic regression models were used to examine the correlation between online STI information searching and offline physician visits. RESULTS A total of 503 men completed the survey. Most men (425/503, 84.5%) searched for STI information online. The most commonly used platform to obtain STI information were search engines (402/425, 94.5%), followed by gay mobile apps (201/425, 47.3%). Men reported high trustworthiness of information received from gay mobile apps. Men also reported high interest (465/503, 92.4%) and willingness (463/503, 92.0%) to use a MSM-friendly physician finder function within such apps. Both using general social media (aOR =1.14, 95%CI: 1.04-1.26) and mobile medical apps (aOR =1.16, 95%CI: 1.01-1.34) for online information seeking were associated with visiting a physician. CONCLUSION Online STI information seeking is common and correlated with visiting a physician among YMSM. Cultivating partnerships with the emerging mobile medical apps may be useful for disseminating STI information and providing better physician services to YMSM.
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Affiliation(s)
- Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, China.,University of North Carolina Project - China, Guangzhou, China
| | - Peipei Zhao
- Shenzhen Nanshan Chronic Disease Control Center, Shenzhen, China
| | - Cedric Bien
- University of North Carolina Project - China, Guangzhou, China
| | - Stephen Pan
- University of North Carolina Project - China, Guangzhou, China
| | - Weiming Tang
- University of North Carolina Project - China, Guangzhou, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julia Watson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Yi Ding
- Shenzhen Nanshan Chronic Disease Control Center, Shenzhen, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Chronic Disease Control Center, Shenzhen, China
| | - Joseph D Tucker
- University of North Carolina Project - China, Guangzhou, China. .,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. .,London School of Hygiene and Tropical Medicine, London, UK.
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14
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Cao B, Zhao P, Bien C, Pan S, Tang W, Watson J, Mi G, Ding Y, Luo Z, Tucker JD. Linking young men who have sex with men (YMSM) to STI physicians: a nationwide cross-sectional survey in China. BMC Infect Dis 2018; 18:228. [PMID: 29776395 PMCID: PMC5960109 DOI: 10.1186/s12879-018-3145-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many young men who have sex with men (YMSM) are reluctant to seek health services and trust local physicians. Online information seeking may encourage YMSM to identify and see trustworthy physicians, obtain sexual health services, and obtain testing for sexually transmitted infections (STIs). This study examined online STI information seeking behaviors among Chinese YMSM and its association with offline physician visits. METHODS We conducted a nationwide online survey among YMSM through WeChat, the largest social media platform in China. We collected information on individual demographics, sexual behaviors, online STI information seeking, offline STI testing, and STI physician visits. We examined the most commonly used platforms (search engines, governmental websites, counseling websites, generic social media, gay mobile apps, and mobile medical apps) and their trustworthiness. We assessed interest and willingness to use an MSM-friendly physician finder function embedded within a gay mobile app. Logistic regression models were used to examine the correlation between online STI information searching and offline physician visits. RESULTS A total of 503 men completed the survey. Most men (425/503, 84.5%) searched for STI information online. The most commonly used platform to obtain STI information were search engines (402/425, 94.5%), followed by gay mobile apps (201/425, 47.3%). Men reported high trustworthiness of information received from gay mobile apps. Men also reported high interest (465/503, 92.4%) and willingness (463/503, 92.0%) to use a MSM-friendly physician finder function within such apps. Both using general social media (aOR =1.14, 95%CI: 1.04-1.26) and mobile medical apps (aOR =1.16, 95%CI: 1.01-1.34) for online information seeking were associated with visiting a physician. CONCLUSION Online STI information seeking is common and correlated with visiting a physician among YMSM. Cultivating partnerships with the emerging mobile medical apps may be useful for disseminating STI information and providing better physician services to YMSM.
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Affiliation(s)
- Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, China.,University of North Carolina Project - China, Guangzhou, China
| | - Peipei Zhao
- Shenzhen Nanshan Chronic Disease Control Center, Shenzhen, China
| | - Cedric Bien
- University of North Carolina Project - China, Guangzhou, China
| | - Stephen Pan
- University of North Carolina Project - China, Guangzhou, China
| | - Weiming Tang
- University of North Carolina Project - China, Guangzhou, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julia Watson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Yi Ding
- Shenzhen Nanshan Chronic Disease Control Center, Shenzhen, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Chronic Disease Control Center, Shenzhen, China
| | - Joseph D Tucker
- University of North Carolina Project - China, Guangzhou, China. .,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. .,London School of Hygiene and Tropical Medicine, London, UK.
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