Testing together behaviors in secondary distribution of HIV/syphilis self-testing program among men who have sex with men in China


BACKGROUND: HIVST is recommended as a promising way to increase the HIV testing uptake among MSM. Partners testing together with HIVST kits were common in HIVST programs. However, limited data was reported on testing together behaviors with social network contacts beyond partners. The objective of the study is to understand the testing together behaviors among both sexual networks and social networks among MSM in an HIVST secondary distribution program.
METHODS: Data were collected among MSM in China from June 2018 to November 2019. Eligible participants (referred to as 'indexes') finished a baseline survey and applied self-test kits. Indexes were encouraged to distribute the self-test kits to other people (referred to as 'alters'). Indexes finished a three-month follow-up survey and provided information on the distribution of the self-test kits. Alters were invited to conduct an online survey on the usage of self-test kits after they returned the photographed testing results. The primary outcomes of this study were the testing together behaviors of indexes and alters.
RESULTS: A total of 371 indexes and 264 alters were included in our analysis. After three months, 138 indexes successfully motivated others for HIVST and the majority of them (107/138, 77.5%) tested together with at least one alters. Around half of the alters (138/264, 52.3%) reported testing together with indexes. More self-kits were distributed to gay friends than sexual partners and more untested men were reached by friends than sexual partners. Indexes and alters who had ever tested for HIV were more likely to test together (aOR = 2.03, 95% CI: 1.07-3.86); (aOR = 1.75, 95% CI: 1.05-2.93). Alters who had one sexual partner in the past six months (aOR = 3.40, 95% CI: 1.77-6.53), used condom in the last sex (aOR = 2.44, 95% CI: 2.11-5.37), and were stable sex partners of indexes (aOR = 7.33, 95% CI: 2.41-22.29) were more likely to test with indexes.
CONCLUSIONS: Our study demonstrated the differences on distributing HIVST among sexual networks and social networks. The social network-based approach is essential in promoting testing together and HIV status disclosure among MSM.