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The Impact of Providing Free HIV Self-testing on Sexual Risk Behaviors Among Men who have Sex with Men in Hunan, China: A Randomized Controlled Trial

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Abstract

HIV self-testing (HIVST) increases testing frequency among men who have sex with men (MSM). However, its impact on sexual risk behaviors is unclear. In a randomized controlled trial conducted in Hunan Province, China, HIV-negative MSM were randomized to receive one of two interventions for one year: (1) facility-based HIV testing, or (2) facility-based HIV testing augmented with free HIVST. From April to June 2018, 230 MSM were enrolled. They self-reported sexual behaviors every 3 months for 12 months. Among 216 MSM with follow-ups (intervention: 110; control: 106), adjusting for potential confounders in Generalized Estimating Equation models, there were no statistically significant differences in consistent condom use with male partners (regular/casual) or female partners, nor on number of male or female sexual partners. Provision of free HIVST kits does not increase risky sex and should be included in comprehensive HIV prevention packages, particularly for sexual minority men in China.

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Data Availability

The study data are available upon request by contacting Ms. Yan Shen at yan_shen@csu.edu.cn, who is independent of the authors.

Code Availability

Not applicable.

References

  1. National Center for AIDS/STD Control and Prevention of China. The latest core information on HIV prevention in 2020. Available at: https://ncaids.chinacdc.cn/zxzx/zxzx/202011/t20201130_222996.htm. Accessed May 1 2022.

  2. Zou H, Wu Z, Yu J, et al. Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Bei**g and Urumqi, China. J Acquir Immune Defic Syndr. 2010;53(Suppl 1):81-7.

    Google Scholar 

  3. Wang HY, Xu JJ, Zou HC, et al. Sexual Risk Behaviors and HIV Infection among Men Who Have Sex with Men and Women in China: Evidence from a Systematic Review and Meta-Analysis. Biomed Res Int. 2015;2015:850132.

    Article  Google Scholar 

  4. The Joint United Nations Programme on HIV and AIDS. Fast-Track - Ending the AIDS epidemic by 2030; 2014. Available at: https://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report. Accessed February 24 2022.

  5. General Office of the State Council of China. The “13th Five-year Plan” on HIV prevention and control in China; 2017. Available at: http://www.gov.cn/zhengce/content/2017-02/05/content_5165514.htm. Accessed February 24 2022.

  6. Jamil MS, Prestage G, Fairley CK, et al. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. Lancet HIV. 2017;4(6):e241-e50.

    Article  Google Scholar 

  7. Zhang C, Koniak-Griffin D, Qian HZ, et al. Impact of providing free HIV self-testing kits on frequency of testing among men who have sex with men and their sexual partners in China: A randomized controlled trial. PLoS Med. 2020;17(10):e1003365.

    Article  Google Scholar 

  8. Ortblad KF, Kibuuka Musoke D, Ngabirano T, et al. The Effect of HIV Self-Testing Delivery Models on Female Sex Workers’ Sexual Behaviors: A Randomized Controlled Trial in Urban Uganda. AIDS Behav. 2019;23(5):1225–39.

    Article  Google Scholar 

  9. Balan IC, Carballo-Dieguez A, Frasca T, Dolezal C, Ibitoye M. The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men. AIDS Behav. 2014;18(2):254–62.

    Article  Google Scholar 

  10. Frye V, Wilton L, Hirshfied S, et al. “Just Because It’s Out There, People Aren’t Going to Use It.“ HIV Self-Testing Among Young, Black MSM, and Transgender Women. AIDS Patient Care STDS. 2015;29(11):617–24.

    Article  Google Scholar 

  11. Liu Y, Sun X, Qian HZ, et al. Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China. AIDS Patient Care STDS. 2015;29(9):481–9.

    Article  Google Scholar 

  12. Ortblad KF, Harling G, Chimbindi N, Tanser F, Salomon JA, B€arnighausen T. Does incident circumcision lead to risk compensation? Evidence from a population cohort in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2019 Mar 1;80(3):269–275.

  13. Westercamp N, Agot K, Jaoko W, Bailey RC. Risk compensation following male circumcision: results from a two-year prospective cohort study of recently circumcised and uncircumcised men in Nyanza Province, Kenya. AIDS Behav. 2014;18(9):1764–75.

    Article  Google Scholar 

  14. Wilde GJS. Target risk: dealing with the danger of death, disease and damage in everyday decisions. Toronto: PDE; 1994.

    Google Scholar 

  15. Blumenthal J, Haubrich R. Risk compensation in PrEP: an old debate emerges yet again. Virtual Mentor. 2014;16(11):909–15.

    Google Scholar 

  16. Holt M, Murphy DA. Individual versus community-level risk compensation following preexposure prophylaxis of HIV. Am J Public Health. 2017;107(10):1568–71.

    Article  Google Scholar 

  17. Fonner V, Dalglish S, Kennedy C, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS.2016 Jul 31;30(12):1973–83.

  18. Walensky RP, Paltiel AD. Rapid HIV testing at home: does it solve a problem or create one? Ann Intern Med. 2006;145(6):459–62.

    Article  Google Scholar 

  19. Napierala S, Bair EF, Marcus N, et al. Male partner testing and sexual behaviour following provision of multiple HIV self-tests to Kenyan women at higher risk of HIV infection in a cluster randomized trial. J Int AIDS Soc. 2020;23(Suppl 2):e25515.

    Google Scholar 

  20. Chen YH, Gilmore HJ, Maleke K, et al. Increases in HIV status disclosure and sexual communication between South African men who have sex with men and their partners following use of HIV self-testing kits. AIDS Care. 2021;33(10):1262–69.

    Article  Google Scholar 

  21. Ren XL. The influence of HIV self-testing on seeking facility-based HIV service and risk sexual behaivors among men who have sex with men in Bei**g. Thesis, Chinese Center for Disease Control and Prevention; 2017.

  22. Tang W, Huang W, Lu H, et al. What happens after HIV self-testing? Results from a longitudinal cohort of Chinese men who have sex with men. BMC Infect Dis. 2019;19(1):807.

    Article  Google Scholar 

  23. Zhang C, Li X, Koniak-Griffin D, Goldsamt LA, Zhou J. Effectiveness of self-testing kits availability on improving HIV testing frequency for chinese men who have sex with men and their sexual partners: a protocol for a multicenter randomised controlled trial. BMJ open. 2018;8(12):e024423.

    Article  Google Scholar 

  24. Ministry of Health of the People’s Republic of China. 2016 China AIDS response progress report. 2016. Available at: http://hunan.sina.com.cn/news/2016-11-27/detail-ifxyawmp0324958.shtml?from=hunan_ydph. Accessed February 24 2022.

  25. HIV epidemic in Hunan Province at the end of October. 2016 (in Chinese). Available at: http://www.eol.cn/hunan/hunannews/201611/t20161128_1471024.shtml. Accessed February 24 2022.

  26. Wang XD, Ma H. Rating scales for mental health. Chinese journal of mental health. 1999.

  27. Liu** G. Generalized estimation equations for longitudinal data analysis. Prev Med. 2018;30(01):106–07.

    Google Scholar 

  28. W P. Akaike’s Information Criterion in Generalized Estimating Equations. Biometrics. 2001;57(1):120–25.

  29. Ren XL, Wu ZY, Mi GD, et al. HIV care-seeking behaviour after HIV self-testing among men who have sex with men in Bei**g, China: a cross-sectional study. Infect Dis Poverty. 2017;6(1):112.

    Article  Google Scholar 

  30. Feng L, Ding X, Lu R, et al. High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China’s largest municipality: an alarming epidemic in Chongqing, China. J Acquir Immune Defic Syndr. 2009;52(1):79–85.

    Article  Google Scholar 

  31. Wang Y, Li LL, Zhang GG, et al. Analysis on the intention of marriage and the influence factors among unmarried men who have sex with men. Zhonghua Liu **ng Bing Xue Za Zhi. 2012;33(10):1031–5.

    Google Scholar 

  32. Zhang DC, Chen ZH, Ma Y, Wu ZY. Qualitative study on unprotected sexual behaviors among male students who have sex with men in Bei**g. Zhonghua yu fang yi xue za zhi. 2018;52(12):1234–38.

  33. Neville S, Adams J, Moorley C, Jackson D. The condom imperative in anal sex - one size may not fit all: a qualitative descriptive study of men who have sex with men. J Clin Nurs. 2016;25(23–24):3589–96.

    Article  Google Scholar 

  34. Chakrapani V, Boyce P, Newman PA, Row Kavi A. Contextual influences on condom use among men who have sex with men in India: subjectivities, practices and risks. Cult Health Sex. 2013;15(8):938–51.

    Article  Google Scholar 

  35. Grulich A, ** F, Bavinton B, et al. Long-term protection from HIV infection with oral HIV pre-exposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPIC-NSW prospective implementation study. Lancet HIV. 2021;8(8):e486–94.

    Article  Google Scholar 

  36. Cresswell F, Asanati K, Bhagani S, et al. UK guideline for the use of HIV post-exposure prophylaxis 2021. HIV Med. 2022 May;23(5):494–545.

    Article  Google Scholar 

  37. The Joint United Nations Programme on HIV and AIDS. Power to the people. Available at: https://www.unaids.org/sites/default/files/media_asset/power-to-the-people_en.pdf. Accessed May 3 2022.

  38. Han J, Bouey J, Wang L, et al. PrEP uptake preferences among men who have sex with men in China: results from a National Internet Survey. J Int AIDS Soc. 2019;22(2):e25242.

    Article  Google Scholar 

  39. Wang Y, Liu S, Zhang Y, et al. Use of HIV Post-Exposure Prophylaxis Among Men Who Have Sex With Men in Shenzhen, China: A Serial Cross-Sectional Study. AIDS Behav.2022. doi: https://doi.org/10.1007/s10461-022-03673-x.

  40. Eaton LA, Kalichman SC. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep. 2007;4(4):165–72.

    Article  Google Scholar 

  41. Rojas CD, Delabre RM, Molina JM. Give PrEP a chance: moving on from the “risk compensation” concept. J Int AIDS Soc. 2019;22(S6):e25351.

    Google Scholar 

  42. Calabrese SK, Mayer KH, Marcus JL. Prioritising pleasure and correcting misinformation in the era of U = U. Lancet HIV. 2021;8(3):e175–80.

    Article  Google Scholar 

  43. Venter F, Majam M, Jankelowitz L, et al. South African HIV self-testing policy and guidance considerations. South Afr J HIV Med. 2017;18(1):775.

    Article  Google Scholar 

  44. Ren **an L, Wu Zun Y, Mi Guo D, et al. Uptake of HIV Self-testing among Men Who have Sex with Men in Bei**g, China: a Cross-sectional Study. Biomed Environ Sci. 2017;30(6):407–17.

    Google Scholar 

  45. Wu Y, ** Potential Pre-Exposure Prophylaxis Users onto a Motivational Cascade: Identifying Targets to Prepare for Implementation in China. LGBT Health. 2019;6(5):250–60.

    Article  Google Scholar 

  46. Hou J, Wu Y, Lu **e L, et al. Post-exposure prophylaxis: an underutilized biomedical HIV prevention method among gay, bisexual and other men who have sex with men in China. AIDS Care. 2020;32(12):1573–80.

    Article  Google Scholar 

  47. Huang Z, Wang M, Fu L, et al. Intervention to increase condom use and HIV testing among men who have sex with men in China: a meta-analysis. AIDS Res Hum Retroviruses. 2013;29(3):441–8.

    Article  CAS  Google Scholar 

  48. Sullivan P, Stephenson R, Hirshfield S, et al. Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men. J Med Internet Res. 2022;24(2):e34574.

    Article  Google Scholar 

  49. Patel V, Rawat S, Dange A, et al. An Internet-Based, Peer-Delivered Messaging Intervention for HIV Testing and Condom Use Among Men Who Have Sex With Men in India (CHALO!): Pilot Randomized Comparative Trial. JMIR Public Health Surveill. 2020;6(2):e16494.

    Article  Google Scholar 

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Acknowledgements

We appreciate all participants for joining in this RCT and the staff in Zuo An Cai Hong (the gay-friendly CBO) for their assistance in recruitment process. This study was supported by Fogarty International (D43 TW009579), Central South University Innovation-driven project (2018CX036), Central South University Graduate Independent Exploration Innovation project (2021zzts0335), and Hunan Graduate Scientific Research Innovation Project (CX20210345).

Funding

This study was supported by Fogarty International (D43 TW009579), Central South University Innovation-driven project (2018CX036), Central South University Graduate Independent Exploration Innovation project (2021zzts0335), and Hunan Graduate Scientific Research Innovation Project (CX20210345).

Author information

Authors and Affiliations

  1. **angya School of Nursing, Central South University, 172, Tongzipo Road, Yuelu District, 410013, Changsha, Hunan Province, China

    Ci Zhang, Honghong Wang & **anhong Li

  2. Rory Meyers College of Nursing, New York University, New York, NY, USA

    Lloyd A. Goldsamt

  3. College of Public Health, East Tennessee State University, Johnson City, TN, USA

    Shimin Zheng

  4. School of Public Health, Yale University, New Haven, CT, USA

    Han-Zhu Qian

  5. School of Public Health, San Diego State University, San Diego, CA, USA

    Qing Li

  6. School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA

    Qing Li

  7. School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA

    Deborah Koniak-Griffin

Authors
  1. Ci Zhang
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  4. Han-Zhu Qian
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Contributions

Lloyd A. Goldsamt, **anhong Li, and Deborah Koniak-Griffin design the research study. Ci Zhang, Honghong Wang, and **anhong Li performed the research. Ci Zhang, Honghong Wang, and **anhong Li acquired the data. Ci Zhang, Shimin Zheng, and **anhong Li analyzed the data. Ci Zhang, Lloyd A. Goldsamt, Shimin Zheng, Han-Zhu Qian, Honghong Wang, **anhong Li, and Deborah Koniak-Griffin contributed to the interpretation of the data. Ci Zhang prepared the initial draft of the manuscript. Ci Zhang, Lloyd A. Goldsamt, Shimin Zheng, Han-Zhu Qian, Honghong Wang, Qing Li, **anhong Li, and Deborah Koniak-Griffin revised the manuscript. All authors contributed to and approved the final version of the manuscript.

Corresponding author

Correspondence to **anhong Li.

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Conflict of Interest

Dr. Qian is now with GSK plc. Other authors declare that they have no conflict of interest.

Ethics Approval

Ethical approval was obtained from the institutional review board for behavioral and nursing research in Central South University **angya Nursing School (approval # 2018002).

Consent to Participate

An oral informed consent for rapid HIV testing at screening and a written informed consent for participation in the trial were obtained prior to enrollment in the study.

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Not applicable.

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Zhang, C., Goldsamt, L.A., Zheng, S. et al. The Impact of Providing Free HIV Self-testing on Sexual Risk Behaviors Among Men who have Sex with Men in Hunan, China: A Randomized Controlled Trial. AIDS Behav 27, 708–718 (2023). https://doi.org/10.1007/s10461-022-03804-4

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