Decentralized STD Testing Among Men Who Have Sex With Men in South China -- a Qualitative Analysis to Inform Sexual Health Services

Abstract

Background: Health services for men who have sex with men (MSM) are inadequate around the world. HIV and syphilis test uptake remain suboptimal among MSM in China and many other regions. To inform the development of more comprehensive sexually transmitted disease (STD) testing programs among MSM, we collected descriptive data on MSM testing practices and preferences.

Methods: MSM in two large urban Chinese cities were recruited through community-based organizations to participate in semi-structured interviews. We purposively sampled MSM across a range of sociodemographic characteristics and testing history, and assessed preferences for HIV and syphilis testing in the context of facilitators and barriers to testing and previous testing experiences. Each interview transcript was coded and thematically analyzed using Atlas.ti 7.0.

Results: 35 MSM were interviewed. Confidentiality and privacy were the most important factors influencing participants’ decisions about whether and where to test. Many men described feeling discriminated against when testing at hospitals or government testing centers. Men preferred rapid testing (results available within 30 minutes) compared to conventional tests where results take several hours or days to return. MSM described concerns about quality and accuracy of rapid tests offered in decentralized settings such as community-based organizations. Preferred service provider characteristics included: MSM-friendly, non-discriminatory, and medically trained professionals. Preferred service center environments included: convenient but discrete location, MSM-friendly atmosphere, and clean/standard medical facilities.

Conclusion: Our data highlight the need for MSM HIV/STD testing services that are confidential and inclusive of MSM. Rapid testing in decentralized settings provides an opportunity to reach individuals who have not been tested before, but must be accompanied by quality assurance systems and technical competence. Further implementation research must evaluate decentralized STD testing pilot programs for MSM and continue building capacity for MSM-focused sexual health services.