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Bridging the HIV-syphilis testing gap: dual testing among men who have sex with men living in China
  1. Jason J Ong1,2,3,
  2. Meizhen Liao4,
  3. Amy Lee2,
  4. Hongyun Fu2,5,
  5. Stephen W Pan2,6,7,
  6. Weiming Tang2,6,
  7. Chongyi Wei8,
  8. Wu Dan2,6,
  9. Bin Yang2,9,
  10. Ligang Yang9,
  11. Cheng Wang9,
  12. Joseph D Tucker1,2,6
  1. 1 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
  3. 3 Central Clinical School, Monash University, Melbourne, Australia
  4. 4 Shandong Centre for Disease Control and Prevention, Jinan, China
  5. 5 Eastern Virginia Medical School, Norfolk, Virginia, USA
  6. 6 University of North Carolina, Chapel Hill, North Carolina, USA
  7. 7 Department of Public Health, Xi’an Jiaotong-Liverpool University, Suzhou, China
  8. 8 School of Public Health, Rutgers University, New Brunswick, New Jersey, USA
  9. 9 Southern Medical University Dermatology Hospital, Guangzhou, China
  1. Correspondence to Dr Joseph D Tucker, University of North Carolina Project, Guangzhou 510095, China; jdtucker{at}


Objectives The WHO recommends dual testing for HIV and syphilis among key populations, including men who have sex with men (MSM). We assessed the proportion of men who had dual tested and reasons for not dual testing.

Methods In 2017, an online survey of MSM was conducted in eight cities from two provinces in China. Data on sociodemographics and sexual behaviours were collected. Descriptive analysis was used to examine the experience of dual testing. Multivariable logistic regression identified characteristics associated with men who had dual tested.

Results Among 802 men who had ever tested for HIV, 297 dual tested (37%, 95% CI 34 to 40). Men dual tested in a variety of settings: public hospital (35%), voluntary counselling and testing sites (28%), self-testing at home (18%), community-based organisation (8%), community health centre (7%), other (3%) or private hospital (1%). Greater odds for dual testing was found in men who had disclosed their sexuality to a healthcare provider (adjusted OR (AOR) 1.81, 95% CI 1.27 to 2.59, p=0.001), and who had substantial (AOR 2.71, 95% CI 1.67 to 4.41, p<0.001) or moderate community engagement in sexual health (AOR 2.30, 95% CI 1.49 to 3.57, p<0.001), compared with those with no community engagement. The most common reasons for not dual testing were no knowledge that they could be dual tested (34%), did not ask the doctor to be dual tested (25%) and did not believe they were at risk for syphilis (19%).

Conclusions Chinese MSM are dual testing through a variety of test sites, including home self-testing. However, the overall dual testing rate remains low despite recent efforts to integrate HIV and syphilis testing.

  • HIV
  • syphilis
  • dual test
  • China
  • men who have sex with men

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  • Handling editor Jackie A Cassell

  • Contributors JDT, WT, CW and JJO contributed to the conception and design of the study. CW and BY provided oversight for data collection and ML, LY, WC and WD assisted in the data collection. AL assisted with the literature search. JJO, SWP and HF analysed the data and JJO drafted the paper. All authors revised the manuscript and approved the final version to be published.

  • Funding Funding has been received from the National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532-01), UNC Center for AIDS Research (NIAID 5P30AI050410), UCSF Center for AIDS Research (NIAID P30 AI027763), NIMH (R00MH093201), UJMT Fogarty Fellowship (FIC R25TW0093), Australian National Health and Medical Research Council (APP1104781) and SESH Global ( Administrative assistance from the Guangdong Provincial Center for Skin Diseases and STI Control, UNC Chapel Hill and UNC Project-China in Guangzhou, China.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Guangdong Provincial Centre for Skin Diseases and STI Control (1R01AI114310) and the University of North Carolina at Chapel Hill (14-1865).

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