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Untested and undiagnosed: barriers to HIV testing among men who have sex with men, Beijing, China
  1. Xuefeng Li1,
  2. Hongyan Lu2,
  3. H F Raymond3,
  4. Yanming Sun2,
  5. Yujiang Jia4,5,
  6. Xiong He2,
  7. Song Fan1,
  8. Yiming Shao1,
  9. Willi McFarland3,4,
  10. Yan Xiao1,
  11. Yuhua Ruan1
  1. 1State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
  2. 2Beijing Center for Disease Control and Prevention, Beijing, P. R. China
  3. 3San Francisco Department of Public Health, San Francisco, California, USA
  4. 4Institute for Global Health, Vanderbilt University School of Medicine, Nashville, USA
  5. 5Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, USA
  1. Correspondence to Dr Willi McFarland, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102-6033, USA; willi_mcfarland{at}hotmail.com

Abstract

Objectives Undiagnosed HIV presents great potential for the spread of infection. The authors identify the prevalence and correlates of never testing and being unaware of HIV infection in Beijing men who have sex with men (MSM).

Methods Cross-sectional biological and behavioural survey using respondent-driven sampling; 500 MSM were included.

Results HIV prevalence was 7.2% with 86.1% unaware of their infection; 33.2% had never tested. Never testing was associated with lower educational (adjusted odds ratio (AOR) 1.6, 95% CI (CI) 1.1 to 2.5), living in Beijing for ≤3 years (AOR 1.5, 95% CI 1.0 to 2.3), unprotected anal intercourse with most recent male partner (AOR 1.6, 95% CI 1.0 to 2.4), being unaware of the most recent male partner's HIV status (AOR 3.6, 95% CI 2.1 to 6.1) and holding stigmatised attitudes towards persons with HIV (AOR 1.1 per scale point, 95% CI 1.0 to 1.1). Predictors of having undiagnosed HIV infection were being married (AOR 2.4, 95% CI 1.0 to 5.4), living in Beijing for ≤3 years (AOR 3.6, 95% CI 1.5 to 8.4), being unaware of the most recent male partner's HIV status (AOR 6.8, 95% CI 0.9 to 51.6) and holding negative attitudes towards safe sex (AOR 1.1 per scale point, 95% CI 1.0 to 1.1).

Conclusions Recent attention has focused on HIV prevention interventions that depend upon knowing one's serostatus, including viral load suppression, prevention with positives, pre-exposure prophylaxis and seroadaptation. Until the low level of testing and resulting high level of undiagnosed HIV infection are addressed, these tools are not likely to be effective for MSM in China.

  • HIV
  • gay men
  • men who have sex with men
  • China
  • HIV testing
  • undiagnosed HIV infection
  • epidemiology
  • street youth
  • homosexual
  • sexual behaviour
  • risk behaviours
  • AIDS
  • HSV-2
  • epidemiology (general)
  • public health
  • CHINA
  • STD control
  • trials
  • STD
  • HCV
  • risk factors
  • viral
  • HBV

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Footnotes

  • Funding This study was funded by grant R01 AI078933 from the National Institutes of Health of the USA and by the Ministry of Science and Technology of China (2008ZX10001-004, 2008ZX10001-010 and 2009DFB30420).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval National Center for AIDS/STD Control and Prevention (NCAIDS) in China and Vanderbilt University and the University of California San Francisco in the USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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