AIDS and Behavior

, Volume 16, Issue 5, pp 1138–1147 | Cite as

A Randomized Controlled Trial to Evaluate the Relative Efficacy of Enhanced Versus Standard Voluntary Counseling and Testing on Promoting Condom Use among Men Who Have Sex with Men in China

  • Chun Hao
  • Xiping Huan
  • Hongjing Yan
  • Haitao Yang
  • Wenhui Guan
  • Xiaoqin Xu
  • Min Zhang
  • Na Wang
  • Weiming Tang
  • Jing Gu
  • Joseph T. F. LauEmail author
Original Paper


The randomized controlled trial investigated the relative efficacy of an enhanced (EVCT) versus standard (SVCT) voluntary counseling and testing in reducing unprotected anal intercourse (UAI) among men who have sex with men (MSM) in China. 295 participants who recruited by respondent driven sampling methods were randomly allocated to the two arms. In addition to the SVCT, the EVCT group watched a theory-based video narrated by a HIV positive MSM, received enhanced counseling and a reminder gift. As compared to the SVCT group, the EVCT group reported lower prevalence of UAI with any male sex partners (48.4% versus 66.7%, RR = 0.7, ARR = −18.3%, p = 0.010) and with regular male sex partners (52.2% versus 68.9%, RR = 0.8, ARR = −16.7%, p = 0.043) at Month 6, whilst baseline between-group differences were statistically non-significant. Between-group differences in HIV/syphilis incidence were statistically non-significant. Translational research should be conducted to integrate non-intensive enhancements such as the EVCT into regular testing services.


Randomized controlled trial Men who have sex with men Voluntary HIV counseling and testing Intervention HIV/STD 



We thank the study participants for their contributions, and X. Wu, Y. Zhu, Q. Wei, Z. Pu, Heizi, Zhuimeng, W. Xu, J. Ji and H. Guo for registration, HIV counseling, HIV screening and confirming. We also thank the NGO of Jiangsu Tongtian offering assistance through the whole study. This study is financially supported by Jiangsu Provincial Technologies Research Program, No. BE2009685.


  1. 1.
    Yang H, Hao C, Huan X, et al. HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing, China. Sex Transm Dis. 2010;37(4):208–13.Google Scholar
  2. 2.
    Hao C, Yan H, Yang H, et al. The incidence of syphilis, HIV and HCV and associated factors in a cohort of men who have sex with men in Nanjing, China. Sex Transm Infect. 2011;87(3):199–201.PubMedCrossRefGoogle Scholar
  3. 3.
    Feng L, Ding X, Lu R, et al. High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China’s largest municipality: an alarming epidemic in Chongqing, China. J Acquir Immune Defic Syndr. 2009;52(1):79–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Feng Y, Wu Z, Detels R, et al. HIV/STD prevalence among men who have sex with men in Chengdu, China and associated risk factors for HIV infection. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S74–80.PubMedGoogle Scholar
  5. 5.
    He Q, Wang Y, Lin P, et al. High prevalence of risk behaviour concurrent with links to other high-risk populations: a potentially explosive HIV epidemic among men who have sex with men in Guangzhou, China. Sex Transm Infect. 2009;85(5):383–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Jiang J, Cao N, Zhang J, et al. High prevalence of sexually transmitted diseases among men who have sex with men in Jiangsu Province, China. Sex Transm Dis. 2006;33(2):118–23.PubMedCrossRefGoogle Scholar
  7. 7.
    Li SW, Zhang XY, Li XX, et al. Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005–2006. Chin Med J (Engl). 2008;121(12):1105–8.Google Scholar
  8. 8.
    Ma X, Zhang Q, He X, et al. Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. J Acquir Immune Defic Syndr. 2007;45(5):581–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Ruan S, Yang H, Zhu Y, et al. Rising HIV prevalence among married and unmarried among men who have sex with men: Jinan, China. AIDS Behav. 2009;13(4):671–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Gao MY, Wang S. Participatory communication and HIV/AIDS prevention in a Chinese marginalized (MSM) population. AIDS Care. 2007;19(6):799–810.PubMedCrossRefGoogle Scholar
  11. 11.
    Zhang H, Wu Z, Zheng Y, Wang J, Zhu J, Xu J. A pilot intervention to increase condom use and HIV testing and counseling among men who have sex with men in Anhui, China. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):S88–92.PubMedGoogle Scholar
  12. 12.
    Lau JT, Lau M, Cheung A, Tsui HY. A randomized controlled study to evaluate the efficacy of an Internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong. AIDS Care. 2008;20(7):820–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Wang M, Wang XF, Duan Y. Analysis of historical behavioral data related to HIV from China-UK integrated program on STDs/HIV. Soft Sci Health. 2006;20:185–90. (Chinese).Google Scholar
  14. 14.
    Shi TX, Zhang BC, Li XF. Study on intervention targeted AIDS high risk sex behaviors among MSM. Chin J AIDS/STD. 2003;9:365–7. (Chinese).Google Scholar
  15. 15.
    Zhang BC, Li XF, Shi TX. High risk sex behaviors related to STD/HIV infection and intervention pattern for male homosexuals. Chin J Irpr Skin Dis. 2002;18:22–4. (Chinese).Google Scholar
  16. 16.
    Hong FC, Zhou H, Cai YM, et al. Prevalence of syphilis and HIV infections among men who have sex with men from different settings in Shenzhen, China: implications for HIV/STD surveillance. Sex Transm Infect. 2009;85(1):42–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Herbst JH, Sherba RT, Crepaz N, et al. A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr. 2005;39(2):228–41.PubMedGoogle Scholar
  18. 18.
    Kamb ML, Fishbein M, Douglas JM Jr, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. JAMA. 1998;280(13):1161–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Thomas B, Mimiaga MJ, Menon S, et al. Unseen and unheard: predictors of sexual risk behavior and HIV infection among men who have sex with men in Chennai, India. AIDS Educ Prev. 2009;21(4):372–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Wu Z, Sun X, Sullivan S, Detels R. HIV testing in China—active testing for HIV among high-risk groups. Science. 2006;312(5779):1475–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Hesketh T, Duo L, Li H, Tomkins AM. Attitudes to HIV and HIV testing in high prevalence areas of China: informing the introduction of voluntary counselling and testing programmes. Sex Transm Infect. 2005;81:108–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Koralage N. China to offer free HIV testing and treatment. BMJ. 2004;328:975.PubMedCrossRefGoogle Scholar
  23. 23.
    CMOH & China CDC. Manual for HIV voluntary counseling and testing. Beijing, China; 2001.Google Scholar
  24. 24.
    Lau JT, Siah PC, Tsui HY. A study of the STD/AIDS related attitudes and behaviors of men who have sex with men in Hong Kong. Arch Sex Behav. 2002;31(4):367–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Zheng Y, Chen J, Liu L, Zhang R, Sun J, Lu H. Understanding the behavioral and social characteristics of VCT clients in a Shanghai hospital. China. AIDS Care. 2010;22(7):909–14.CrossRefGoogle Scholar
  26. 26.
    Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. Am J Public Health. 1999;89(9):1397–405.PubMedCrossRefGoogle Scholar
  27. 27.
    Prochaska JO, Velicer WF, Rossi JS, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol. 1994;13(1):39–46.PubMedCrossRefGoogle Scholar
  28. 28.
    Ajzen I. The theory of planned behaviour. Organ Behav Human Decis Process. 1991;50:179–211.CrossRefGoogle Scholar
  29. 29.
    Choi KH, Yep GA, Kumekawa E. HIV prevention among Asian and Pacific Islander American men who have sex with men: a critical review of theoretical models and directions for future research. AIDS Educ Prev. 1998;10(3 Suppl):19–30.PubMedGoogle Scholar
  30. 30.
    Gullette DL, Turner JG. Stages of change and condom use among an Internet sample of gay and bisexual men. J Assoc Nurses AIDS Care. 2004;15(2):27–37.PubMedCrossRefGoogle Scholar
  31. 31.
    Johnson WD, Diaz RM, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev. 2008:CD001230.Google Scholar
  32. 32.
    Tudiver F, Myers T, Kurtz RG, et al. The Talking Sex Project: results of a randomized controlled trial of small-group AIDS education for 612 gay and bisexual men. Eval Health Prof. 1992;15(4):26–42.CrossRefGoogle Scholar
  33. 33.
    Richardson JL, Milam J, McCutchan A, et al. Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004;18(8):1179–86.PubMedCrossRefGoogle Scholar
  34. 34.
    Dilley JW, Woods WJ, Loeb L, et al. Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: results from a randomized controlled trial using paraprofessional counselors. J Acquir Immune Defic Syndr. 2007;44(5):569–77.PubMedCrossRefGoogle Scholar
  35. 35.
    Calderon Y, Haughey M, Bijur PE, Leider J, Moreno-Walton L, Torres S, Gennis P, Bauman LJ. An educational HIV pretest counseling video program for off-hours testing in the emergency department. Ann Emerg Med. 2006;48(1):21–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Warner L, Klausner JD, Rietmeijer CA, et al. Effect of a brief video intervention on incident infection among patients attending sexually transmitted disease clinics. PLoS Med. 2008;5(6):e135.PubMedCrossRefGoogle Scholar
  37. 37.
    Chiasson MA, Shaw FS, Humberstone M, Hirshfield S, Hartel D. Increased HIV disclosure three months after an online video intervention for men who have sex with men (MSM). AIDS Care. 2009;21(9):1081–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Sweat M, O’Donnell C, O’Donnell L. Cost-effectiveness of a brief video-based HIV intervention for African American and Latino sexually transmitted disease clinic clients. AIDS. 2001;15(6):781–7.PubMedCrossRefGoogle Scholar
  39. 39.
    May S, West R, Hajek P, Hao C. The use of videos to inform smokers about different nicotine replacement products. Patient Educ Couns. 2003;51:143–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Weston J, Hannah M, Downes J, Hao C. Evaluating the benefits of a patient information video during the informed consent process. Patient Educ Couns. 1997;30:239–45.PubMedCrossRefGoogle Scholar
  41. 41.
    Guo H, Wei JF, Yang H, Huan X, Tsui SKW, Zhang C. Rapidly increasing prevalence of HIV and syphilis and HIV-1 subtype characterization among men who have sex with men in Jiangsu, China. Sex Transm Dis. 2009;36(2):120–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden population. Soc Probl. 1997;44:174–99.CrossRefGoogle Scholar
  43. 43.
    Yeka W, Maibani-Michie G, Prybylski D, Colby D. Application of respondent driven sampling to collect baseline data on FSWs and MSM for HIV risk reduction interventions in two urban centres in Papua New Guinea. J Urban Health. 2006;83(6 Suppl):i60–72.PubMedCrossRefGoogle Scholar
  44. 44.
    Glanz K, Rimer BK, Lewis FM. Health behavior and health education. Theory, research and practice. San Fransisco: Wiley; 2002.Google Scholar
  45. 45.
    Miller WR, Rollnick SR. Motivational interviewing, preparing people for change. 2nd ed. New York: The Guilford Press; 2002.Google Scholar
  46. 46.
    Vickers AJ. The use of percentage change from baseline as an outcome in a controlled trial is statistically inefficient: a simulation study. BMC Med Res Methodol. 2001;1:6.PubMedCrossRefGoogle Scholar
  47. 47.
    Wu Z. HIV/AIDS among MSM in China. China national conference for MSM prevention and treatment 2008; Beijing; 2008.Google Scholar
  48. 48.
    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(1):250.PubMedCrossRefGoogle Scholar
  49. 49.
    Summers T, Spielberg F, Collins C, Coates T. Voluntary counseling, testing, and referral for HIV: new technologies, research findings create dynamic opportunities. J Acquir Immune Defic Syndr. 2000;25(Suppl 2):S128–35.PubMedCrossRefGoogle Scholar
  50. 50.
    Olley BO. Improving well-being through psycho-education among voluntary counseling and testing seekers in Nigeria: a controlled outcome study. AIDS Care. 2006;18(8):1025–31.PubMedCrossRefGoogle Scholar
  51. 51.
    van der Snoek EM, de Wit JB, Gotz HM, Mulder PG, Neumann MH, van der Meijden WI. Incidence of sexually transmitted diseases and HIV infection in men who have sex with men related to knowledge, perceived susceptibility, and perceived severity of sexually transmitted diseases and HIV infection: Dutch MSM-Cohort Study. Sex Transm Dis. 2006;33(3):193–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Zhang D, Bi P, Lv F, Tang H, Zhang J, Hiller JE. Internet use and risk behaviours: an online survey of visitors to three gay websites in China. Sex Transm Infect. 2007;83(7):571–6.PubMedCrossRefGoogle Scholar
  53. 53.
    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.PubMedCrossRefGoogle Scholar
  54. 54.
    Woolf SH. The meaning of translational research and why it matters. JAMA. 2008;299(2):211–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Chun Hao
    • 1
    • 2
    • 3
  • Xiping Huan
    • 4
  • Hongjing Yan
    • 4
  • Haitao Yang
    • 4
  • Wenhui Guan
    • 4
  • Xiaoqin Xu
    • 4
  • Min Zhang
    • 5
  • Na Wang
    • 5
  • Weiming Tang
    • 6
  • Jing Gu
    • 1
    • 2
    • 3
  • Joseph T. F. Lau
    • 2
    • 3
    Email author
  1. 1.Shool of Public HealthSun Yat-Sen UniversityGuangzhouChina
  2. 2.Center for Health Behaviours Research, School of Public Health and Primary Care, Faculty of MedicineThe Chinese University of Hong Kong, 5/F, School of Public Health and Primary Care, Prince of Wales HospitalHong Kong Special Administrative RegionChina
  3. 3.Centre for Medical Anthropology and Behavioral HealthSun Yat-Sen UniversityGuangzhouChina
  4. 4.Jiangsu Provincial Central for Disease Control and PreventionNanjingChina
  5. 5.Nanjing Central for Disease Control and PreventionNanjingChina
  6. 6.Nanjing Medical UniversityNanjingChina

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