HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men MSM in China.
Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing including HIV self-testing history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, men completed the survey. Among them, A minority Similar were also found for receiving HIV serostatus disclosure from casual partners.
Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM. A study conducted by members of our research team found that the HIV incidence in two cities in Jiangsu Province was as high as HIV serostatus disclosure could facilitate serosorting and seropositioning, promote condom use, improve uptake to HIV prevention and treatment programs, and increase HIV test uptake. Worldwide, studies on HIV serostatus disclosure mainly focused on whether an index HIV case disclosed their serostatus to their partner sand mainly focused on heterosexual couples.
These studies usually reported on the patterns 20 and processes 21 of HIV serostatus disclosure, evaluated barriers and benefits of HIV serostatus disclosure 22and assessed factors associated with HIV positive test disclosure. And very few of them explored the association between coerced HIV testing history and history of post-test violence, while these two are considered to be highly correlated with HIV serostatus disclosure.
We defined receiving HIV serostatus disclosure as the partner of a participant actively disclosing their HIV serostatus to the participant.
In addition, studies on providing HIV serostatus disclosure were usually based on the face-to-face interview, which tends to have report bias and social desirability. A computer-assisted online survey could be another good choice, even we cannot completely prevent social desirability bias 27as no face-to-face interview is involved. To answer these questions, we conducted secondary data analysis of a randomized control trial, with the aims of accessing the proportion of men who had received HIV serostatus disclosure from partners before sex, and evaluating factors associated with receiving HIV serostatus disclosure from their most recent regular and casual male partner.
These cities were chosen for two reasons: 1the selected sites have the heaviest burden of HIV in the two provinces; 2each city had existing infrastructure for MSM HIV surveillance led by the local center for diseases prevention and control CDC and capacity to deliver new HIV testing services.
The inclusion criteria of this study included: born as a male, at least 16 years old, ever engaged in anal sex with another man, currently living in one of the deated cities, and electronically ed the online written informed consent form. To recruit participants, our study team collaborated with a gay partner seeking smart-phone based application called Blued. Participants could forward the survey link to friends. Participants who clicked the survey link on the social media application were directed to the online survey that was hosted by Sojump Shanghai, China.
After study eligibility was determined, eligible participants were required to give informed consent prior to beginning the survey, by ing the inform consent form electronically. Participants could take the survey on a cell phone, tablet, laptop or desktop computer, and the survey took the participants about For reference, the average household net income in in China was approximately USD, and approximately increased to USD in Participants were asked to report their self-identified sexual orientation gay, bisexual, and heterosexual or unsure.
In addition, participants were asked to report their current self-identified gender male, transgender or unsure. Sex partners and Norfolk Virginia ma sexual behaviors, participants were asked if they had used a condom with their last male partner Yes or noand if their last male partner was a regular or casual partner.
Casual male partner was defined as any sexual partner that the participant did not consider to be his regular partner, while regular partner was defined as boyfriends or any sexual-relationship that last for more than three months. Information on coerced HIV testing history, and history of post-test violence Yes or no was also collected. We defined post-test violence as the HIV testing leading to a violent confrontation physical assault to the participants.
HIV testing social norm was measured by six validated items asking participants about the social norms of HIV testing.
Each item was then scored between 1 and 4, based on the answers provided by the participants. And the mean scores for all the sex items of social norm and self-efficacy were then calculated ranged between 1 to 4.
The Cronbach's alphas for social norm and self-efficacy are 0. Hence, each participant was able to report HIV partner statuses for a maximum of four partners. We defined receiving HIV serostatus disclosure as the partner of a participant actively disclosing their HIV serostatus to the participant.
Providing disclosure of HIV status from the participant to partners was assessed analogously. Descriptive analysis was used to describe the distribution of the socio-demographic characteristics and behaviors of participants. Univariate and multivariate logistic regression were used to evaluate factors associated with receiving HIV status disclosure from the most recent male regular partner of the participants. We analyzed the factors associated with receiving HIV status disclosure from the most recent male regular partners as well as the most recent male casual partners Table 1.
Factors that were adjusted in the multivariate analyses included age continuouseducation level, marital status, annual income and city of recruitment. Model building and confounder selection was informed by the of a literature search and prior knowledge from work of the study group and collaborators.
Overall, the survey link was clicked 36, times from 25, independent IP addresses, and a total of 2, eligible participants finished the questionnaire many people clicked the survey link but withdrew before the eligible screening. Among these 2, participants, seven records were removed after de-duplication of redundant mobile phone s.
The final analytic sample included 2, participants. About two-thirds of the participants In addition, over seventy percent of participants Overall, 1, In addition, 67 3. The mean social norm score on HIV testing of the participants was 2.
Overall, participants Of these people who know their HIV status, 62 5. In addition, A total of 64 5. Among the people who reported have regular male partners, only HIV serostatus disclosure rates from other different kinds of partners were: people Among the 62 HIV positive participants, 37 Among the HIV negative participants, All of these were based on self-reporting.
Multivariate analysis indicated that, compared to people with HIV negative testingparticipants who never tested for HIV or whose HIV status was unknown were less likely to receive disclosure of HIV status from their most recent regular partners, with an adjusted Odds Ratio aOR of 0.
Compared with people who never tested for syphilis, participants who ever tested for syphilis had higher odds of receiving HIV status disclosure from regular partners, with an aOR of 1. We found that post-test violence was positively associated with test disclosure from regular male partners, with aOR of 5. In addition, with the increase of HIV testing related self-efficacy, the likelihood of receiving HIV serostatus disclosure from regular male partners also increased, with an aOR of 1.
Similar were found for factors associated with receiving HIV serostatus disclosure from their most recent casual male partners Table 4.
HIV serostatus disclosure before sex can facilitate serosorting, seropositioning, condom use and potentially decrease the risk of HIV acquisition. We found that only about one-quarter of regular partners disclosed their HIV serostatus to the participants. This partner disclosure rate and partner status knowledge rate was much lower than the findings of one study conducted among MSM in Nanjing In addition, qualitative studies that aim to identify other reasons that may impede HIV serostatus disclosure among Chinese MSM would be essential for developing targeted interventions.
In our study, the disclosure rate from participants to their partners was relatively high compared to the disclosure rate from partners to the participants. Report bias and disparity of HIV status disclosure from different partners could be two potential reasons for this phenomenon.
studies indicated that promoting HIV testing, especially couples-based HIV testing, was essential for facilitating HIV serostatus disclosure across diverse settings.
Receiving hiv serostatus disclosure from partners before sex: from an online survey of chinese men who have sex with men
studies indicated that post-violence is one potential barrier to HIV serostatus disclosure 4546and our study found corroborating. However, post-test violence is very rarely reported among Chinese MSM. For example, only 14 men 1. Interventions and further implementation research to facilitate safe disclosure are still urgently needed for MSM.
Our study has several limitations. First, as an online study conducted on the mobile application, our study was prone to selection bias. Participants would at least have a smart phone, which led our sample to tend to be young and well educated 43and many potential participants who clicked the survey link withdrew before the eligibility screening.
Second, the cross-sectional de precluded us to identify any causal relationships. Third, as all data socio-demographic, behaviors, and HIV testing were collected through self-report, our study may suffer from information bias. Fourth, recall bias might have occurred when we collected information on HIV serostatus disclosure. Fifth, even the total sample size for our study is large, only a few people experienced rare outcomes, such as post-test violence.
Also, even we have used a validated scale, the Cronbach's alphas for self-efficacy was only 0. Policies that focus on dealing with the sociocultural and structural barriers of HIV serostatus disclosure, and to promote HIV testing and HIV serostatus disclosure tly are essential.
Robin lewis ph.d. (clinical psychology)
In addition, qualitative and quantitative research should elucidate unexplored barriers to HIV status disclosure, develop and evaluate new intervention methods for promoting HIV status disclosure, among Chinese MSM and transgender individuals.
National Center for Biotechnology InformationU. AIDS Behav. Author manuscript; available in PMC Dec 1. Stephen W. Joseph D. Author information Copyright and information Disclaimer. Copyright notice. See other articles in PMC that cite the published article. Abstract Background HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition.