An Internet-Based Self-Testing Model (Easy Test): Cross-Sectional Survey Targeting Men Who Have Sex With Men Who Never Tested for HIV in 14 Provinces of China.

BACKGROUND: With China's explosive internet growth, activities such as socializing and partner seeking among men who have sex with men (MSM) has also become Web based through popular services such as Blued. This creates a new mode of health promotion with the potential to instantly reach large numbers of MSM, including those who rarely access traditional offline testing facilities. OBJECTIVE: This study aimed to assess the feasibility of the Easy Test in increasing access and uptake of HIV testing and treatment services among MSM and to identify demographic and behavioral predictors of program uptake to inform future implementation. METHODS: A feasibility study of the Easy Test model was conducted from October 2017 to December 2017 in 14 Chinese provinces. Applicants who provided informed consent completed a self-administered questionnaire and submitted a US $5 deposit to have the free test kit delivered to their homes. Orders were then received, processed, and posted by volunteers from local community-based organizations. Once applicants submitted images of their test results, the deposit was refunded to the applicant. Those whose test results were deemed to be HIV-positive were then connected to a peer navigator to accompany the individual to follow-up medical services. A chi-squared trend test was used to assess the relationship between lifetime HIV testing volume and HIV prevalence. Logistic regression models were used to identify independent risk factors associated with two outcomes: (1) never having tested for HIV and (2) receiving an HIV-positive result. RESULTS: A total of 879 individuals submitted Web-based requests for test kits. Their median age was 28 (interquartile range 24-34 years); 69.3% (609/879) had at least a college education, and 51.5% (453/879) had a monthly income between US $450 to $750; 77.7% (683/879) of the applicants submitted images of their test results, among whom 14.3% (98/683) had an HIV-positive result. Among the 42.9% (293/683) who were first-time testers, the HIV prevalence was 18.8% (55/293). Nearly three-quarters (71/98, 72.4%) of those with a positive test result were connected with a peer navigator and enrolled in treatment. Among the first-time testers, having multiple sexual partners (2-3 sexual partners: adjusted odds ratio [aOR] 2.44, 95% CI 1.08-5.50; 4 or above sexual partners: aOR 3.55, 95% CI 1.18-10.68) and reporting inconsistent condom use in the previous 3 months (aOR 7.95, 95% CI 3.66-17.26) were both associated with an HIV-positive result. An inverse dose response relationship between lifetime HIV testing volume and HIV prevalence was also observed in this study (χ23=55.0; P<.001). CONCLUSIONS: The Easy Test model reached a larger portion of first-time testers, many who reported higher risk sexual behaviors. This highlights the potential for an internet-based self-test model to increase access to HIV treatment services for HIV-positive MSM in China.

[Characteristics of HIV's sexual behavior and their effect on the secondary transmission rate].

OBJECTIVE: To analyze the sexual behavior characteristics of the sexually transmitted HIV-positive people and to estimate the secondary transmission rate.
 METHODS: Field investigation and literature review were conducted among sexually transmitted HIV-positive people to collect general information during the last 6 months before notification of HIV infection. A mathematical model was used to estimate the secondary transmission rate.
 RESULTS: A total of 769 HIV-positive people were recruited for the study, 186 of them were women, 286 were men who have sex with women (MSW), 242 were men who have sex with men (MSM) and 55 were men who have sex with men and women (MSMW). During 6 months, the average sex partner among these 4 groups were 2.29, 1.61, 3.32 and 4.10, respectively; the sexual behavior frequency were 26.03, 20.97, 14.77 and 25.51, respectively; the rates of non-use of condom were 74.14%, 73.53%, 59.60% and 72.06%, respectively; the secondary transmission rate were 0.0095, 0.0151, 0.1759 and 0.1985, respectively. Under constant conditions of other factors, the secondary transmission rates decreased by 30.13%-82.00%, 23.00%-49.51%, and 16.10%-19.09%, respectively, if there was a reduction in 1 sex partner, 1 time/month for the sexual frequency and 20% of rate for non-use of condom.
 CONCLUSION: The HIV secondary transmission from MSMW HIV-positive people to general population was the highest. Change in sexual behavior of the HIV-positive people can decrease the HIV secondary transmission rate significantly.

[Study on the risk of HIV transmission by heterosexual contact and the correlation factors].

OBJECTIVE: To understand the associated factors on human immunodeficiency virus (HIV) transmission via heterosexual contact and to provide evidence for decision-maker for prevention of HIV.
 METHODS: Questionnaire survey was conducted in 250 HIV-positive persons to understand their socio-demographic characteristics and sexual behavior. Meanwhile, 431 persons who had heterosexual contact with the HIV carriers were traced to their HIV infection status. The factors associated with continued HIV transmission were reviewed by case-control analysis.
 RESULTS: Among the 432 persons, 59 were HIV-positive because of heterosexual contact. The secondary attack rate and the growth rate was 13.7% (59/431) and 0.236 (59/250), respectively. The factors associated with the spread of HIV included: the degree of knowledge on HIV/AIDS, psychological reflection after infection, the condition for condom usage among spouses, and regular sexual partners or non regular sexual partners.
 CONCLUSION: The secondary attack rate and the growth rate of HIV transmission by heterosexual contact are high. Improvement of the knowledge about HIV/AIDS prevention and control, enhancement of psychological education and promotion of condom usage can reduce the risk for continued HIV transmission.

[A study on the risk and its determinants of HIV transmission by syringe sharing among HIV-positive drug users].

OBJECTIVE: To understand the risks and associated factors of HIV transmission by sharing syringes among HIV-positive drug users. METHOD: The survey was conducted among HIV-positive injecting drug users (IDUs-HIV+) who received HIV counseling, testing and treatment in Changsha city Infectious Disease Hospital and Hengyang city No.3 People's Hospital from July 2012 to May 2013 to understand their socio-demographic characteristics, HIV prevalence and syringe sharing. A total of 503 IDUs-HIV+ were involved in and provided the contact list of 2 460 drug users who had the syringe sharing experience over one month with IDUs-HIV+. 420 IDUs-HIV+ among 503 were defined as infection sources due to sharing syringe with at least one drug user. Among them, 234 HIV-negative persons were in control group, and 186 HIV-positive were in cased group. A total of 1 220 drug users were followed up among 2 460 and defined as vulnerable population. The HIV transmission rate was calculated based on the HIV prevalence among vulnerable population. Based on the result of HIV transmission to vulnerable population from 420 infection sources, case-control study and the multivariate logistic regression analysis were adopted to explore the associated factors of HIV transmission among IDUs-HIV+. RESULTS: As the sources of HIV transmission, 420 IDUs-HIV+ had an average duration of (4.5 ± 1.2) years for drug use. As a susceptible population, 1 220 drug users sharing syringes with the 420 IDUs-HIV+ had an average duration of (1.1 ± 0.5) years for drug use. There were 238 HIV-positive persons among 1 220 vulnerable drug users, with a transmission rate of 0.57. In the case-control study, the proportion of male subjects was 87.1% (162/186) in the case group, which was higher than that in the control group (77.8%, 182/234). The proportion of subjects who received support after knowing their HIV infection status was 51.1% (95/186) in the case group, which was lower than that in the control group (79.5%, 186/234). The proportion of subjects sharing syringes every time of using drugs was 47.8% (89/186) in the case group, which was higher than that in the control group (36.8%, 86/234). The proportion of subjects having AIDS awareness was 21.0% (39/186) in the case group, which was lower than that in the control group (64.5%, 151/234); the proportion of subjects having close contact with HIV-positive persons for more than 106 days was 60.2% (112/186) in the case group, which was higher than that in the control group (31.6%, 74/234). The proportion of subjects maintaining the original drug use method after being infected with HIV was 50.5% (94/186) in the case group, which was higher than that in the control group (16.7%, 39/234) (all P values < 0.05). The multivariate logistic regression analysis was carried out to analyse high correlate factors of HIV transmission by sources of transmission, and the AIDS awareness, duration of contact between sources of transmission and vulnerable population, access to support following confirmed HIV infection were protective factors, OR (95% CI) values were 0.155 (0.104-0.262), 0.170 (0.106-0.253), and 0.306 (0.189-0.450), respectively; while the frequency of syringe sharing and continuous drug use after being infected with HIV were risk factors, and the OR (95% CI) values were 3.06 (1.77-5.29), and 3.54 (2.16-5.80), respectively. CONCLUSION: HIV transmission by IDUs-HIV+ might be contained by raising AIDS awareness, providing comprehensive psychological support, conducting needle exchange and methadone maintenance treatment and reducing syringe sharing.

Estimating the population size of men who have sex with men: a modified Laska, Meisner and Siegel procedure taking into account internet populations.

OBJECTIVES: Men who have sex with men (MSM) are an at-risk population for HIV/AIDS. Accurately estimating the size of MSM is important to monitor the HIV/AIDS epidemic and to implement HIV/AIDS prevention in the MSM population. None of the current methods for MSM population size estimation is satisfactory, especially for internet samples. We try to use the modified Laska, Meisner and Siegel (LMS) method to estimate the size of MSM in tangible venues and internet virtual venues. METHODS: Laska, Meisner and Siegel developed an unbiased estimator for the size of a population in a single venue based on a single sample (LMS method). In this study, we modified the LMS method for the estimation of population size of MSM (LMS* procedure). Specially, we integrated the MSM size of traditional tangible venue with internet virtual venue. Currently, the latter is an important source of socialisation for MSM population. To do this, we added a few parameters to the original LMS method. Then we applied the LMS* procedure to estimate the size of MSM in Changsha, the capital city of the Chinese Province of Hunan. RESULTS: The LMS* procedure handled the complexity of socialisation among MSM population well. According to the LMS* procedure, the total number of MSM was 65 657 (95% CI 57 922 to 73 388), constituting a proportion of 5.43% (95% CI 4.79% to 6.07%) in the sexually active male population (15-64-year-olds) in Changsha. CONCLUSIONS: We conclude that the LMS* procedure is suitable for the estimation of a hard-to-reach population, such as MSM, in tangible venues and internet virtual venues.

[Study on the causes of sexual orientation of gay].

OBJECTIVE: To explore the relevant factors of the causes of sexual orientations of gay. METHOD: From March to June 2013, 350 gays were recruited from one music bar and three bath centers where gays frequently visited in Changsha city, by proportional stratified sampling method. Meanwhile, another 332 males who identify themselves as non-homosexuality were also recruited considering the composition of ages, gender and educational background. Questionnaire survey was conducted to all the subjects, with 300 effective ones reclaimed. The questionnaire included the general demographic information, traits of character, the condition of foster in childhood and information of family members. The differences between the gays and non-homosexuality groups were analyzed to explore the causes of the sexual orientations of gays. RESULTS: There were statistical significant differences between gays and non- homosexuality group on following indexes (χ(2) was 59.63, 5.90, 16.01, 84.99, 161.57, 77.77, 112.32, 190.84, 30.10 respectively, all of P < 0.05) :had a tender father and an impervious mother, were physically weak, not agile, physically inactive, attentive to details, highly conservative, not adventurous, and radical in childhood, were raised as girls before the age of 18, liked to dress as girls before the age of 18, don't liked to play toy knives and toy guns before the age of 18, suffered from sexual abuse before the age of 18 (e.g. forced to expose private parts or forced to have sex) by adults, had read or watched books or films about homosexual and experienced sexual pleasure from that before the age of 18. The rate of gays on these indexes was separately 62.3% (187/300), 57.7% (173/300) , 62.3% (187/300) , 63.0% (189/300), 67.3% (202/300) , 62.7% (189/300), 68.0% (204/300), 65.0% (195/300) and the rate on these indexes of non-homosexuality group was separately 21.3% (64/300), 28.0% (84/300) , 25.0% (75/300) , 12.7% (38/300), 31.3% (94/300), 17.7% (53/300) , 12.7% (38/300), 42.7% (128/300) . The rate of gays on these factors:the youngest boy in family, had the father or twin brothers who were homosexual or self identified as gay was 62.7% (188/300), 56.0% (168/300) and 62.0% (18/29) respectively; and the rate was 40.7% (122/300), 4.0% (12/300) and 20.0% (2/10), respectively among non-homosexuality group. The difference showed statistical significance (χ(2) was 34.52, 193.14, 5.27 respectively, all of P < 0.05). CONCLUSION: The correlative factor of sexual orientation of gays maybe was family relationship, tend and education since childhood, psychological characteristics, sexual experience during puberty.

The Practice and Potential Role of HIV Self-testing in China: Systematic Review and Meta-analysis.

BACKGROUND: HIV self-testing (HIVST) is recommended by the World Health Organization as a valid approach to routine HIV testing services. The scale of HIVST use has gradually been expanded in China over the past 5 years. To take a closer look at the role of HIVST in China, we reviewed the promotion and application of HIVST within China. OBJECTIVE: The main objective of this study was to systematically analyze the proportion of past use and actual uptake of HIVST within China. Moreover, we aimed to quantify the effect of HIVST on HIV prevention and treatment. METHODS: In all, 5 medical databases and 2 registration systems, including PubMed, Web of Science, MEDLINE, WanFang, China National Knowledge Internet, ClinicalTrials.gov, and the Chinese Clinical Trial Registry were systematically searched for studies reporting the prevalence of HIVST use from January 1, 2010, to December 25, 2021. Meta-analyses of the pooled proportion estimates were carried out by the meta-package in R software (version 4.1.2). Statistical heterogeneity among the studies was estimated using Cochran Q test and the inconsistency index (I2). RESULTS: A total of 50 studies were included in our systematic review. The estimated pooled prevalence of HIVST use in China was 29.9% (95% CI 22.5%-37.9%). Among individuals who have ever used HIVST, 47.5% (95% CI 37.2%-57.8%) were tested for HIV for the first time. The pooled reactive rate of HIVST was 4.2% (95% CI 3.1%-5.8%). When HIVST revealed a reactive result, 81.3% (95% CI 70.9%-91.6%) of individuals sought medical care. CONCLUSIONS: In recent times, HIVST has become a valuable tool for HIV prevention in China. The widespread use of HIVST in non-men who have sex with men populations needs to be endorsed and promoted. The long-term applications of HIVST and the potential consequences of self-financing of HIVST in China have yet to be explored. TRIAL REGISTRATION: PROSPERO CRD42022304846; https://tinyurl.com/54d9pxy8.

[Analysis of HIV/syphilis/HCV infection among drug users in 15 cities, China].

OBJECTIVE: To study the HIV infection rate and relevant behavioural characteristics among drug users (DUs) in the 15 cities of China-Gates HIV/AIDS Program. METHODS: By literature review from the public security sector and expert consultations, the size of drug using population was estimated, questionnaire was used to survey relevant behavioural characteristics of DUs, and blood specimens were collected for HIV, syphilis and HCV testing. RESULTS: In 2007, the number of registered DUs in the 15 cities was 176 004, while the estimated number was 477 989. DUs mainly used heroin and crystal meth. Of the survey subjects, 41.0% (2685/6155) had correct knowledge about HIV/AIDS, and Hangzhou 97.6% (410/420), Qingdao 85.5% (342/400), Wuhan 69.7% (308/442), Kunming 63.8% (255/400), Shanghai 45.4% (237/522), Xi'an 44.5% (178/400), Nanjing 38.8% (155/400), Beijing 36.5% (237/650), Guangzhou 29.5% (122/413), Haerbin 25.4% (114/447), Haikou 23.8% (96/402), Chongqing 22.4% (90/401), Sanya 20.0% (80/400), Tianjin 16.2% (41/253), Shenyang 9.8% (20/205), and the difference among the cities has statistical significance (χ(2) = 1482.833, P < 0.05). The rate of needle sharing at the last injection was 10.8% (665/6155), and Hangzhou 10.8% (45/420), Chongqing 26.4% (106/401), Guangzhou 2.6% (11/413), Shenyang 31.3% (64/205), Shanghai 0.4% (2/522), Kunming 10.8% (43/400), Beijing 10.6% (69/650), Tianjin 5.4% (14/253), Xi'an 3.3% (13/400), Wuhan 17.9% (79/442), Sanya 20.0% (80/400), Haikou 2.2% (9/402), Haerbin 8.5% (38/447), Nanjing 21.4% (86/400), Qingdao 1.5% (6/400), and the difference among the cities has statistical significance (χ(2) = 483.044, P < 0.05). Only 5.0% (8737/176 004) of DUs and 1.2% of HIV positive DUs participated in needle exchange. The HIV, syphilis and HCV infection rates were respectively 2.76% (155/5620), 3.38% (190/5620) and 32.35% (1818/5620). The HIV infection rates of different city was:Hangzhou 0.4% (1/273), Chongqing 7.5% (30/401), Guangzhou 2.9% (12/413), Shenyang 0.5% (1/205), Shanghai 0.32% (1/316), Kunming 16.25% (65/400), Beijing 2.6% (16/624), Tianjin 2.0% (5/253), Xi'an 1.25% (5/400), Wuhan 0.24% (1/411), Sanya 1.75% (7/400), Haikou 0.2% (1/402), Haerbin 1.1% (5/447), Nanjing 1.1% (3/275), Qingdao 0.5% (2/400), and the difference among the cities has statistical significance (χ(2) = 354.203, P < 0.05). CONCLUSION: The HIV prevalence rate of IDUs in 15 cities slowly decreased although the HIV prevalence rate of IDUs in Chongqing and Kunming and other cities had surpassed the international warning level. The risk of sharing needles for HIV infection was dropped, and more attention should be paid to the potential risk of HIV transmission via unsafe sex due to the use of new drugs, such as amphetamine chloride.

HIV Self-Testing Programs to Men Who Have Sex With Men Delivered by Social Media Key Opinion Leaders and Community-Based Organizations are Both Effective and Complementary: A National Pragmatic Study in China.

BACKGROUND: Social media key opinion leaders (SMKOLs) and community-based organizations (CBOs) are 2 leading delivery strategies for HIV self-testing (HIVST). This study compared respondent characteristics, linkage to care, antiretroviral treatment, and cost of HIVST among men who have sex with men (MSM) recruited via SMKOLs and CBOs in China. METHODS: Between January and December 2018, SMKOLs distributed HIVST advertisements to MSM through WeChat public platforms; simultaneously, CBOs distributed HIVST program messages to local MSM. All participants were required to pay a deposit to apply for the HIVST kit and had their deposit refunded after completing an online survey and uploading HIVST results. Trained staff provided HIV referral services by telephone and WeChat. RESULTS: One thousand seven hundred forty-three [63.0% (1743/2766)] and 1023 [37.0% (1023/2766)] individuals met criteria via SMKOLs and CBOs, respectively. MSM reached by SMKOLs had a lower HIV seropositive rate [2.1% (33/1561) vs. 12.5% (100/803)] and higher proportion received antiretroviral treatment [94.4% (31/33) vs. 29.0% (29/100)] compared with CBO-recruited MSM (all P < 0.05). The average number of HIVST respondents recruited by each investigator in SMKOL-strategy was higher than that of CBO-strategy (290 vs. 49). The SMKOLs had lower cost of per person tested (USD 13.18 vs. USD 101.21) and per newly identified HIV infection case (USD 632.66 vs. USD 812.70). CONCLUSIONS: SMKOLs have lower cost of per person tested, whereas CBOs can reach MSM subpopulations with higher HIV seropositive rates. Both recruitment methods are efficient and should be used as complementary HIVST delivery strategies to address low HIV testing coverage among Chinese MSM.

[HIV infection and KAP status among men who have sex with men in 14 Chinese cities].

OBJECTIVE: To explore the current status of HIV infection and HIV-related knowledge, attitude and practice (KAP) among men who have sex with men (MSM) in 14 cities in China. METHODS: A cluster sampling method was administrated and 14 large or medium cities were selected. The respondent-driven sampling (RDS) was also used to conduct a questionnaire survey in 6101 MSM. Blood specimens were collected for HIV and syphilis testing. RESULTS: A total of 6101 MSM were selected and investigated, with an HIV infection rate of 6.3% (384/6101) and a syphilis infection rate of 14.0% (854/6101). The proportion of MSM knowing correct HIV/AIDS knowledge was 59.7% (3644/6101); 6.2% (378/6101) and 11.2% (683/6101) of the respondents ever had buying sex or selling sex in the last six months respectively; the proportion of consistent condom-using each time while with male partners in the last month was 39.2% (2392/6101). The proportion of condom-using while with male partners was 65.2% (3978/6101) in the last time among MSM. CONCLUSION: A high HIV infection rate was observed among MSM with limited HIV/AIDS awareness and high risk behaviors. It is necessary to initiate a rapid response to prevent HIV spreading in MSM.

Evaluation of Blood-Based Antibody Rapid Testing for HIV Early Therapy: A Meta-Analysis of the Evidence.

BACKGROUND: Western blot (WB) assay is considered the gold standard test for HIV infection confirmation. However, it requires technical expertise and is quite time-consuming. WHO recommends blood-based rapid diagnosis to achieve same-day test and treatment. However, this rapid testing strategy has not been promoted worldwide due to inadequate research evaluating the effectiveness of rapid tests (RTs) as an alternative confirmatory HIV test for WB. This study aims to compare the diagnostic performance of rapid HIV tests compared with WB. METHODS: PubMed and Web of Science were searched for publications on rapid HIV tests using blood specimen. A meta-analysis was performed to quantitatively evaluate the diagnostic performance of rapid HIV tests compared with the WB assay in terms of pooled sensitivity, specificity, area under summary receiver operating characteristic (SROC) curve, and diagnostic odds ratio (DOR). RESULTS: Twenty articles involving 27,343 fresh specimens for rapid HIV tests were included in the meta-analysis. Regarding Capillus HIV-1/HIV-2, the pooled sensitivity, specificity, area under SROC curve, and DOR derived from six studies were 0.999 (95% CI, 0.956-1.000), 0.999 (95% CI, 0.991-1.00), 1.00 (95% CI, 0.99-1.00), and 1.0 × 106 (95% CI, 2.6 × 104-3.9 × 107) compared with the WB assay, respectively. With respect to Determine HIV-1/2, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 1.00 (95% CI, 0.789-1.000), 0.992 (95% CI, 0.985-0.996), 1.00 (95% CI, 0.99-1.00), and 1.8 × 106 (95% CI 406.049-7.8 × 109) compared with the WB assay, respectively. Regarding two-step serial RTs, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 0.998 (95% CI, 0.991-1.000), 0.998 (95% CI, 0.994-0.999), and 1.00 (95% CI 0.99-1.00) compared with the WB assay, respectively. CONCLUSION: Our meta-analysis results may provide evidenced-based support for substituting RT for WB. Blood-based rapid HIV tests have comparable sensitivity and specificity to WB for HIV early therapy.

[Study on the change of unsafe sexual behaviors and its determinants in HIV-positive persons after being notified as HIV seropositive].

OBJECTIVE: To study the change of unsafe sexual behaviors and its determinants in HIV-positive persons after being notified as HIV seropositive. METHODS: Questionnaires were employed in HIV-positive persons whose testing results being notified over 1 year in Changsha and Hengyang between March 2013 and July 2013. RESULTS: Interview was carried out on 268 HIV-positive persons who reported having considerable variability in unsafe sexual behaviors. The incidence of unsafe sexual behaviors declined from 98.8% to 12.7% after being notified as HIV seropositive. Risk factors related to unsafe sexual behaviors after the notification would include gender (men OR = 0.443, 95% CI: 0.209-0.937) and living with sexual partner (OR = 2.549, 95% CI: 1.053-6.174). CONCLUSION: Notification regarding one's HIV seropositivity could considerably reduce the incidence of unsafe sexual behaviors in HIV-positive persons, however, women and those who were living with sexual partners seemed likely to keep practicing unsafe sexual behavior, thereafter.

Effects of HIV status notification on reducing the risk of sexual transmission of HIV in China.

BACKGROUND: The risk of HIV sexual transmission is much higher among people unaware of their HIV status than among those aware. Only a few studies have indicated that the incidence of unsafe sex can be reduced when people know their HIV status. This study was to investigate this effect in China. METHODS: A cohort study consisting of two surveys was conducted at two different times among a group of people living with HIV/AIDS, whose status was newly diagnosed with HIV via sexual contact, in Shanghai, Chongqing, and Kunming. The first survey was conducted among 823 people tested positive for HIV before notifying them of the HIV status. The second survey was conducted among 650 HIV-positive people at six months following the first survey (after notification of HIV status). The scope of survey covered unsafe sex practices, number of unsafe sexual partners, and frequency of unsafe sexual behaviors over the prior six months. Unsafe sex is defined as unprotected anal or vaginal sex with partners who are HIV positive or whose HIV status is unknown. RESULTS: The proportion of unsafe sex was reduced by about 85% after HIV status notification. The risk of HIV sexual transmission was 15 times higher among persons unaware of their HIV status than among those aware. Approximately 95% of new sexually transmitted HIV infections stemmed from 56% of the infected persons unaware of their HIV status in China. CONCLUSION: Timely HIV status notification has the potential to significantly reduce unsafe sex among HIV-infected persons and reduce the risk for HIV transmission via unsafe sex.

Home-based HIV testing for men who have sex with men in China: a novel community-based partnership to complement government programs.

BACKGROUND: The coverage of HIV testing among Chinese men who have sex with men (MSM) remains low after the scale-up of free HIV testing at government-sponsored testing sites. We evaluated the feasibility of home-based HIV self-testing and the willingness to be HIV tested at community-based organizations (CBO). METHODS: We recruited MSM via on-line advertisement, where they completed an on-line informed consent and subsequent questionnaire survey. Eligible MSM received HIV rapid testing kits by mail, performed the test themselves and reported the result remotely. RESULTS: Of the 220 men taking a home-based HIV self-testing, 33 MSM (15%) were seropositive. Nearly 65% of the men reported that they were willing to take HIV testing at CBO, while 28% preferred receiving free HIV testing in the government programs at local Centers for Disease Control and Prevention (CDC). Older and lower-income MSM, those who self-reported homosexual orientation, men with no history of sexually transmitted diseases and a lower number of sexual partners in the past six months were associated with preference for taking HIV testing at CBOs. The top three self-reported existing barriers for HIV testing were: no perception of HIV risk (56%), fear of an HIV positive result being reported to the government (41%), and fear of a positive HIV test result (36%). CONCLUSION: Home-based HIV self-testing is an alternative approach for increasing the coverage of HIV testing among Chinese MSM. CBO-based HIV testing is a potential alternative, but further studies are needed to evaluate its feasibility.

[Characteristics and the estimated size of men who have sex with men in different venues of one city].

OBJECTIVE: To study the features, safe sex behavior and the size of men who have sex with men (MSM) population in actual and virtual venues in one city. METHODS: We carried out a cross-sectional study in actual and virtual venues, using the Estimated Size of Population from a Single Sample (LMS method) to estimate the size of MSM population. RESULTS: Most MSM in actual venues were 24 - 43 year olds and had received high school education, whereas in virtual venues, the majority of this population were younger than 29 years old and had higher education, including some college students. The awareness of AIDS of the two groups from different venues showed no statistically significant difference, neither the safe sex behaviors. Proportions of the MSM population in actual and virtual venues were 21.22% (16 383, 95%CI: 11 514 - 21 252) and 78.78% (60 830, 95%CI: 57 327 - 64 329), respectively. After adjusting the overlapping part of the MSM from both venues, the total number was between 60 830 and 77 213, constituting a proportion of 5.03% - 6.38% in the sexually active male population (15 - 64 year olds) in this city. CONCLUSION: The size of the MSM population was large but the characteristics were different in the actual or virtual venues. As most MSM preferred going to the virtual venues, intervention program on AIDS-specific strategy in this area, in particular dealing with the Internet, should be strengthened.