Barriers to Expanding HIV Testing Among Male Students Who Have Sex with Men in Chengdu, China

BackgroundIn China, HIV transmission among students who are men having sex with men (MSM) is growing at an alarming rate. This study aimed to explore barriers to expanding HIV testing among student MSM in Chengdu City, China.MethodsA mixed method was used in the study. We first conducted four anonymous focus group discussions with a total of 21 implementers of the HIV campaign in the city. Secondly, the anonymous face-to-face in-depth interviews were performed with 24 student MSM. At last, a cross-sectional survey was conducted among 536 student MSM.ResultsIn the focus group discussions, barriers to promoting HIV testing among student MSM were summarized into four levels: 1) the target-level obstacles included fear of personal information being disclosed, lack of access to HIV testing promotions, and lack of HIV knowledge and risk perceptions; 2) the provider-level challenges were HIV stigma and discrimination, lack of professional training, and extra workload with low payment; 3) the institutional-level inhibitors comprised of manpower shortage with excessive turnover, lack of funding and flexible use of it, and lack of leadership support; and 4) the policy-level barriers contained lack of involvement of MSM communities, lack of emphasis on HIV testing, and ambiguity of implementation details. In the in-depth interviews, the barriers to HIV testing identified by the participants were lack of detailed HIV knowledge and risk perceptions, concerns of confidentiality and privacy, lack of availability of HIV testing information, inconvenient location and open time of HIV testing sites, perceived and internalized homosexuality stigma, and HIV stigma and discrimination. In the cross-sectional study, 68.0% and 59.8% of the student MSM reported having received an HIV test ever and in the past 12 months, respectively. The level of HIV knowledge (adjusted odds ratio=0.84; p-value=0.019) and no affiliation to MSM-oriented organizations (adjusted odds ratio=2.88; p-value<0.001) were significantly associated with not receiving an HIV test in the past 12 months.ConclusionThe cooperation between governments, health facilities, schools, and MSM communities should be considerably strengthened to reinforce HIV health education in schools and to implement innovative strategies of promoting HIV testing among student MSM in China