Skip to main content

Advertisement

SpringerLink
Log in

HIV Testing Among Chinese Men Who Have Sex with Men: The Roles of HIV Knowledge, Online Social Life, and Sexual Identity Concerns

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

HIV testing is critical for timely care and controlling the HIV epidemic among men who have sex with men (MSM), particularly for regions with increasing infection rates such as China. This study investigated HIV testing and associated demographic, psychosocial, and risk behavior factors among internet-using Chinese MSM (n = 332). Most participants received HIV testing before (74.1%), which was associated with more HIV knowledge, online social life, and more frequent condomless anal sex. Among MSM who tested previously (n = 246), 48.4% reported regular HIV testing, which was associated with a greater online social life and less sexual identity concerns (internalized homonegativity and concealment motivation). Findings suggest a two-step approach to engage MSM who never tested for HIV and who do not undergo regular testing. Strategies to promote testing should enhance HIV knowledge, sex education, and online MSM community building. Interventions to increase acceptance and positivity of sexual identity are crucial to regular testing.

Resume

Pruebas del VIH son crítica para cuidado oportuno y controlando la epidemia de VIH entre hombres que tienen sexo con hombres (HSM), particularmente para regiones con tasas de infección en aumento tal como China. Este estudio investigó las pruebas de VIH y la asociada demográfico, psicológicos, y factores de comportamiento de riesgo entre HSH chinos que utilizan internet (n = 332). La mayoría de los participantes recibieron pruebas de VIH antes (74.1%), que se asoció con más conocimiento del VIH, vida social en línea, y sexo anal sin condón más frecuente. Entre HSH que probó previamente (n = 246), 48.4% reportaron pruebas de VIH regulares, que fue asociado con una mayor vida social en línea y menos preocupaciones de identidad sexual (homonegatividad interiorizada y motivación de ocultamiento). Resultados sugieren un enfoque de dos pasos para engancharse HSM que nunca ha probado para VIH y que no someterse pruebas con regularidad. Estrategias para promover las pruebas debería mejorar VIH conocimiento, educación sexual, y HSM construcción comunitaria en línea. Las intervenciones para aumentar la aceptación y la positividad de la identidad sexual son cruciales para las pruebas regulares.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Health and Family Planning Commission of China. 2015 China AIDS Response Progress Report. In: Global AIDS Response Progress Reporting. 2015. p. 1–26.

  2. Chow EPF, Wilson DP, Zhang J, Jing J, Zhang L. Human immunodeficiency virus prevalence is increasing among men who have sex with men in China: findings from a review and meta-analysis. Sex Transm Dis. 2011;38(9):845–57.

    PubMed  Google Scholar 

  3. Rotheram-Borus MJ, Newman PA, Etzel MA. Effective detection of HIV. J Acquir Immune Defic Syndr. 2000;25:105–14.

    Google Scholar 

  4. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, Clark JE. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. Ann Emerg Med. 2007;49(5):575–7.

    Google Scholar 

  5. Liu S, Wang K, Yao S, Guo X, Liu Y, Wang B. Knowledge and risk behaviors related to HIV/AIDS, and their association with information resource among men who have sex with men in Heilongjiang province, China. BMC Public Health. 2010;10:250.

    PubMed  PubMed Central  Google Scholar 

  6. Wu J. From, “Long Yang” and “Dui Shi” to Tongzhi: homosexuality in China. J Gay Lesbian Psychother. 2003;7(1–2):117–43.

    Google Scholar 

  7. Steward WT, Miège P, Choi K-H. Charting a moral life: the influence of stigma and filial duties on marital decisions among Chinese men who have sex with men. PLoS ONE. 2013;8(8):e71778.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Zhang B, Chu Q. MSM and HIV/AIDS in China. Cell Res. 2010;15:858–64.

    Google Scholar 

  9. Bien CH, Best JM, Muessig KE, Wei C, Han L, Tucker JD. Gay apps for seeking sex partners in China: implications for MSM sexual health. AIDS Behav. 2015;19(6):941–6.

    PubMed  PubMed Central  Google Scholar 

  10. Saxton P, Dickson N, Hughes A. Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav. 2013;17(9):3133–44.

    PubMed  Google Scholar 

  11. Noble M, Jones AM, Bowles K, DiNenno EA, Tregear SJ. HIV testing among internet-using MSM in the United States: systematic review. AIDS Behav. 2017;21(2):561–75.

    PubMed  PubMed Central  Google Scholar 

  12. Pachankis JE, Hatzenbuehler ML, Hickson F, Weatherburn P, Berg RC, Marcus U, Schmidt AJ. Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS. 2015;29(10):1239–46.

    PubMed  Google Scholar 

  13. Brito AM, Kendall C, Kerr L, Mota RMS, Guimarães MDC, Dourado I, Pinho AA, Benzaken AS, Brignol S, Reingold AL. Factors associated with low levels of HIV testing among men who have sex with men (MSM) in Brazil. PLoS ONE. 2015;10(6):1–14.

    Google Scholar 

  14. Young SD, Holloway I, Jaganath D, Rice E, Westmoreland D, Coates T. Project HOPE: online social network changes in an HIV prevention randomized controlled trial for African American and Latino men who have sex with men. Am J Public Health. 2014;104(9):1707–12.

    PubMed  PubMed Central  Google Scholar 

  15. Zou H, Hu N, Xin Q, Beck J. HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav. 2012;16:1717–28.

    PubMed  Google Scholar 

  16. Song Y, Li X, Zhang L, Fang X, Lin X, Liu Y, Stanton B. HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China. AIDS Care. 2011;23(2):179–86.

    PubMed  PubMed Central  Google Scholar 

  17. Li R, Pan X, Ma Q, Wang H, He L, Jiang T, Wang D, Zhang Y, Zhang X, Xia S. Prevalence of prior HIV testing and associated factors among MSM in Zhejiang Province, China: a cross-sectional study. BMC Public Health. 2016;16(1):1–8.

    Google Scholar 

  18. Zhou J, Chen J, Goldsamt L, Wang H, Zhang C, Li X. HIV testing and associated factors among men who have sex with men in Changsha, China. J Assoc Nurses AIDS Care. 2018;29(6):932–41.

    PubMed  PubMed Central  Google Scholar 

  19. Li X, Wu G, Lu R, Feng L, Fan W, Xiao Y, Sun Z, Zhang H, Xing H, Shao Y, Ruan Y. HIV-testing behavior and associated factors among MSM in Chongqing, China. Medicine (Baltimore). 2014;93(27):1–9.

    Google Scholar 

  20. Zhao P, Liu L, Zhang Y, Cheng H, Cao B, Liu C, Wang C, Yang B, Wei C, Tucker JD, Tang W. The interaction between HIV testing social norms and self-efficacy on HIV testing among Chinese men who have sex with men: results from an online cross-sectional study. BMC Infect Dis. 2018;18(1):1–8.

    CAS  Google Scholar 

  21. Wei C, Wong T, Liu C, Mao J, Tang S, Yang B, Tucker JD, Zhang TP, Tang W, Han L, Zhang Y. Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int AIDS Soc. 2017;20(1):21372.

    PubMed  PubMed Central  Google Scholar 

  22. Han L, Bien C, Wei C, Muessig K, Yang M, Liu F, Yang L, Meng G, Emch M, Tucker J. An online survey of HIV self testing among MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr. 2014;67(2):216–21.

    PubMed  PubMed Central  Google Scholar 

  23. Tsui HY, Lau JTF. Comparison of risk behaviors and socio-cultural profile of men who have sex with men survey respondents recruited via venues and the internet. BMC Public Health. 2010;10:232–42.

    PubMed  PubMed Central  Google Scholar 

  24. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    PubMed  PubMed Central  Google Scholar 

  25. Emory University. American Men’s Internet Survey (AMIS): online HIV behavioral survey of men who have sex with men. In: PRISM Health. Atlanta, GA; 2014.

  26. Sanchez TH, Zlotorzynska M, Sineath RC, Kahle E, Tregear S, Sullivan PS. National trends in sexual behavior, substance use and HIV testing among United States men who have sex with men recruited online, 2013 Through 2017. AIDS Behav. 2018;22(8):2413–25.

    PubMed  Google Scholar 

  27. Wei C, Yan H, Yang C, Raymond HF, Li J, Yang H. Accessing HIV testing and treatment among men who have sex with men in China: a qualitative study. AIDS Care. 2014;26(3):372–8.

    PubMed  Google Scholar 

  28. Carey MP, Schroder KEE. Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Educ Prev. 2002;14(2):172–82.

    PubMed  PubMed Central  Google Scholar 

  29. Wagenaar BH, Sullivan PS, Stephenson R. HIV knowledge and associated factors among internet-using men who have sex with men (MSM) in South Africa and the United States. PLoS ONE. 2012;7(3):1–8.

    Google Scholar 

  30. Mimiaga MJ, Reisner SL, Cranston K, Isenberg D, Bright D, Daf G, Bland S, Driscoll MA, Vanderwarker R, Vega B, Mayer KH. Sexual mixing patterns and partner characteristics of Black MSM in Massachusetts at increased risk for HIV infection and transmission. J Urban Health. 2009;86(4):602–23.

    PubMed  PubMed Central  Google Scholar 

  31. Pando MA, Balan I, Marone R, Dolezal C, Barreda V, Carballo-Dieguez A, Avila MM. HIV knowledge and beliefs among men who have sex with men (MSM) in Buenos Aires, Argentina. AIDS Behav. 2013;17:1305–12.

    PubMed  PubMed Central  Google Scholar 

  32. Mohr J, Fassinger R. Measuring dimensions of lesbian and gay male experience. Meas Eval Couns Dev. 2000;33:66–90.

    Google Scholar 

  33. Mohr J, Kendra MS. Revision and extension of a multidimensional measure of sexual minority identity: the lesbian, gay, and bisexual identity scale. J Couns Psychol. 2011;58(2):234–45.

    PubMed  Google Scholar 

  34. Liu Y. The survey study of lesbian, gay, bisexual, and transgender identity in Taiwan (master dissertation). Taiwan: National Chi Nan University Institutional Repository; 2015.

    Google Scholar 

  35. R Core Team. R Development Core Team [Internet]. Vol. 55, R: A Language and Environment for Statistical Computing. 2016. p. 275–86. Available from: https://www.r-project.org/.

  36. Huang L, Nehl EJ, Lin L, Meng G, Liu Q, Ross MW, Wong FY. Sociodemographic and sexual behavior characteristics of an online MSM sample in Guangdong, China. AIDS Care. 2014;26(5):648–52.

    CAS  PubMed  Google Scholar 

  37. Hatzenbuehler ML, Nolen-Hoeksema S, Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: results from a prospective study of bereaved gay men. Health Psychol. 2008;27(4):455–62.

    PubMed  Google Scholar 

  38. Mereish EH, Poteat VP, Mereish EH, Poteat VP. A relational model of sexual minority mental and physical health: the negative effects of shame on relationships, loneliness, and health. J Couns Psychol. 2015;62(3):425–37.

    PubMed  PubMed Central  Google Scholar 

  39. Millar BM, Wang K, Pachankis JE. The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: results from a randomized controlled trial with young adult gay and bisexual men. J Consult Clin Psychol. 2016;84(7):565–70.

    PubMed  PubMed Central  Google Scholar 

  40. Feng Y, Wu Z, Detels R. Evolution of men who have sex with men community and experienced stigma among men who have sex with men in Chengdu, China. J Acquir Immune Defic Syndr. 2010;53(SUPPL. 1):98–103.

    Google Scholar 

  41. Zhang D, Bi P, Lv F, Zhang J, Hiller JE. Differences between Internet and community samples of MSM: implications for behavioral surveillance among MSM in China. AIDS Care. 2008;20(9):1128–37.

    PubMed  Google Scholar 

  42. Pan S, Xu JJ, Han XX, Zhang J, Hu QH, Chu ZX, Hai YQ, Mao X, Yu YQ, Geng WQ, Jiang YJ, Shang H. Internet-based sex-seeking behavior promotes HIV infection risk: a 6-year serial cross-sectional survey to MSM in Shenyang, China. Biomed Res Int. 2016;2016:2860346.

    PubMed  PubMed Central  Google Scholar 

  43. Rosser BRS, Wilkerson JM, Smolenski DJ, Oakes JM, Konstan J, Horvath KJ, Kilian GR, Novak DS, Danilenko GP, Morgan R. The future of internet-based HIV prevention: a report on key findings from the Men’s INTernet (MINTS-I,II) sex studies. AIDS Behav. 2011;15(Suppl 1):S91–100. https://doi.org/10.1007/s10461-011-9910-5.

    Article  PubMed  Google Scholar 

  44. Bowen AM, Williams ML, Daniel CM, Clayton S. Internet based HIV prevention research targeting rural MSM: feasibility, acceptability, and preliminary efficacy. J Behav Med. 2008;31(6):463–77.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Holloway IW, Rice E, Gibbs J, Winetrobe H, Dunlap S, Rhoades H. Acceptability of smartphone application-based HIV prevention among young men who have sex with men. AIDS Behav. 2014;18(2):285–96.

    PubMed  PubMed Central  Google Scholar 

  46. Nehl EJ, He N, Wang X, Lin L, Wong FY, Yu F. Feasibility and willingness of using e-technologies for HIV prevention and research targeting Chinese MSM. AIDS Care. 2013;25(7):926–30.

    PubMed  Google Scholar 

  47. Mi G, Wu Z, Wang X, Shi C, Yu F, Li T, Zhang L, McGoogan J, Pang L, Xu J, Rou K. Effects of a quasi-randomized web-based intervention on risk behaviors and treatment seeking among HIV-positive men who have sex with men in Chengdu, China. Curr HIV Res. 2015;13(6):490–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Burki T. Health and rights challenges for China’s LGBT community. Lancet. 2017;389(10076):1286.

    PubMed  Google Scholar 

  49. Cao J, Guo L. Chinese, “Tongzhi” community, civil society, and online activism. Commun Public. 2017;1(4):504–8.

    Google Scholar 

  50. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press; 2011.

    Google Scholar 

Download references

Acknowledgements

This work was affiliated by the Providence/Boston Center for AIDS Research (P30AI042853). We would like to acknowledge Beijing LGBT Center, Division of Psychology for their support.

Funding

This research was supported by a grant from the Global Health Institute of University of Wisconsin-Madison awarded to the first author.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 167 Point Street, Providence, RI, 02901, USA

    Shufang Sun, Laura Whiteley & Larry K. Brown

  2. Division of Child and Adolescent Psychiatry, Bradley and Hasbro Children’s Hospital, Providence, RI, USA

    Larry K. Brown

Authors
  1. Shufang Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Whiteley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Larry K. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shufang Sun.

Ethics declarations

Conflict of interest

None of the authors have any conflicts of interest to report.

Ethical Approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All participants provided their consent to the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, S., Whiteley, L. & Brown, L.K. HIV Testing Among Chinese Men Who Have Sex with Men: The Roles of HIV Knowledge, Online Social Life, and Sexual Identity Concerns. AIDS Behav 24, 437–449 (2020). https://doi.org/10.1007/s10461-019-02471-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-019-02471-2

Keywords

Palabras Clave

Search

Navigation