Psychosocial Correlates of HIV Testing Frequency Among Men Who Have Sex with Men in Guangzhou, China

  • Weibin ChengEmail author
  • James E. Egan
  • Qi Liu
  • Huifang Xu
  • Ron Stall
  • Mackey R. Friedman
Original Paper


We examined sociodemographic and psychosocial factors associated with HIV testing patterns in the past 2 years among 492 HIV-negative men who have sex men (MSM) at an HIV testing center in Guangzhou, China. MSM who tested for HIV frequently were more likely to be older, reside in Guangzhou, and have higher monthly income. Compared with MSM who tested frequently, MSM who never tested were less likely to report that their sexual partner(s) had ever received HIV tests or that their good friends had ever received HIV tests, and were less likely to report having an HIV-positive gay friend or ever discussing HIV with sexual partners; they were more likely to report perceiving barriers to HIV testing. Compared with MSM who tested frequently, those who tested irregularly were less likely to report having HIV-positive gay friends or to disclose their sexual orientation to non-gay friends; reported greater barriers to HIV testing; and higher internalized homophobia.


HIV testing Frequency Psychosocial factors China MSM 



The authors are grateful to the amfAR GMT Program, which provided funding for the first author to receive training in HIV-related social and behavioral research at the University of Pittsburgh. We especially thank Michael Cowing, Kent Kozad, and Monica Coniglio at amfAR for their stewardship. The authors thank all the Staff of the Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, and Lingnan Partner Community Support Center for their contribution in helping the data collection. We also feel grateful for voluntary participation of subjects in the study. Preliminary results informing this manuscript were presented in poster form at the Lancet-CAMS Summit (2017), an abstract of which has been published here: Cheng, W., Friedman, M. R., Egan, J. E., Liu, Q., Xu, H., & Stall, R. (2017). HIV-testing patterns and psycho-social factors associated with frequency of testing by men who have sex with men: implication for scaling up HIV testing in China. The Lancet, 390, S45.


The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research was funded by amfAR, the Foundation for AIDS Research, and Medical Science and Technology Foundation of Guangdong Province (A2018459).

Compliance with Ethical Standards

Conflict of interests

We declare no competing interests.

Ethical Approval

Ethics approval was obtained from the Ethics Review Boards of the Guangzhou Center for Disease Control and Prevention and the University of Pittsburgh (Protocol 15040542).


  1. 1.
    World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, 2016 update. 2016 Populations—2016 update. Geneva: World Health Organization; 2014.Google Scholar
  2. 2.
    UNAIDS. 90–90–90: An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.Google Scholar
  3. 3.
    Furegato M, Mitchell H, Ogaz D, Woodhall S, Connor N, Hughes G, et al. The role of frequent HIV testing in diagnosing HIV in men who have sex with men. HIV Med. 2018;19(2):118–22.CrossRefGoogle Scholar
  4. 4.
    Liu Y, Qian HZ, Ruan Y, Wu P, Osborn CY, Jia Y, et al. Frequent HIV testing: impact on HIV risk among Chinese men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(4):452–61.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention, CDC. HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men—United States. Morb Mortal Wkly Rep. 2013;62(47):958–62.Google Scholar
  6. 6.
    Excellence TNIfHaC. Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among men who have sex with men 2011.
  7. 7.
    Cheng W, Tang W, Zhong F, Babu GR, Han Z, Qin F, et al. Consistently High Unprotected Anal Intercourse (UAI) and factors correlated with UAI among men who have sex with men: implication of a serial cross-sectional study in Guangzhou, China. BMC Infect Dis. 2014;14(1):696.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    MacKellar DA, Valleroy LA, Secura GM, Bartholow BN, McFarland W, Shehan D, et al. Repeat HIV testing, risk behaviors, and HIV seroconversion among young men who have sex with men: a call to monitor and improve the practice of prevention. J Acquir Immune Defic Syndr. 2002;29(1):76–85.CrossRefGoogle Scholar
  9. 9.
    Wu Z, Sun X, Sullivan SG, Detels R. Public health. HIV testing in China. Science. 2006;312(5779):1475–6.CrossRefGoogle Scholar
  10. 10.
    Nelson KM, Pantalone DW, Gamarel KE, Carey MP, Simoni JM. Correlates of never testing for HIV among sexually active Internet-recruited gay, bisexual, and other men who have sex with men in the United States. AIDS Patient Care STDs. 2018;32(1):9–15.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Adam PC, de Wit JB, Toskin I, Mathers BM, Nashkhoev M, Zablotska I, et al. Estimating levels of HIV testing, HIV prevention coverage, HIV knowledge, and condom use among men who have sex with men (MSM) in low-income and middle-income countries. J Acquir Immune Defic Syndr. 2009;52(Suppl 2):S143–51.CrossRefGoogle Scholar
  12. 12.
    Li B, Bi P, Ward A, Bell C, Fairley CK. Trends and predictors of recent HIV testing over 22 years among a clinic sample of men who have sex with men in South Australia. Sex Health. 2017;14(2):164–9.CrossRefGoogle Scholar
  13. 13.
    Holtzman S, Landis L, Walsh Z, Puterman E, Roberts D, Saya-Moore K. Predictors of HIV testing among men who have sex with men: a focus on men living outside major urban centres in Canada. AIDS Care. 2016;28(6):705–11.CrossRefGoogle Scholar
  14. 14.
    Berg RC. Predictors of never testing for HIV among a national online sample of men who have sex with men in Norway. Scand J Public Health. 2013;41(4):398–404.CrossRefGoogle Scholar
  15. 15.
    Zhang L, Xiao Y, Lu R, Wu G, Ding X, Qian HZ, et al. Predictors of HIV testing among men who have sex with men in a large Chinese city. Sex Transm Dis. 2013;40(3):235–40.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    UNAIDS. Country and regional responses to AIDS. Countries 2009.Google Scholar
  17. 17.
    Ngo AD, Ratliff EA, McCurdy SA, Ross MW, Markham C, Pham HT. Health-seeking behaviour for sexually transmitted infections and HIV testing among female sex workers in Vietnam. AIDS Care. 2007;19(7):878–87.CrossRefGoogle Scholar
  18. 18.
    Song Y, Li X, Zhang L, Fang X, Lin X, Liu Y, et al. HIV-testing behavior among young migrant men who have sex with men (MSM) in Beijing, China. AIDS Care. 2011;23(2):179–86.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Phillips KA, Paul J, Kegeles S, Stall R, Hoff C, Coates TJ. Predictors of repeat HIV testing among gay and bisexual men. AIDS. 1995;9(7):769–75.CrossRefGoogle Scholar
  20. 20.
    Huang ZJ, He N, Nehl EJ, Zheng T, Smith BD, Zhang J, et al. Social network and other correlates of HIV testing: findings from male sex workers and other MSM in Shanghai, China. AIDS Behav. 2012;16(4):858–71.CrossRefGoogle Scholar
  21. 21.
    Fernandez MI, Perrino T, Bowen GS, Royal S, Varga L. Repeat HIV testing among Hispanic men who have sex with men—a sign of risk, prevention, or reassurance? AIDS Educ Prev. 2003;15(1 Suppl A):105–16.CrossRefGoogle Scholar
  22. 22.
    Matkovic Puljic V, Kosanovic Licina ML, Kavic M, Nemeth Blazic T. Repeat HIV testing at voluntary testing and counseling centers in Croatia: successful HIV prevention or failure to modify risk behaviors? PLoS ONE. 2014;9(4):e93734.CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Vargas SK, Konda KA, Leon SR, Brown B, Klausner JD, Lindan C, et al. The relationship between risk perception and frequency of HIV testing among men who have sex with men and transgender women, Lima, Peru. AIDS Behav. 2018. Scholar
  24. 24.
    Hutchinson AB, Farnham PG, Sansom SL, Yaylali E, Mermin JH. Cost-effectiveness of frequent HIV testing of high-risk populations in the United States. J Acquir Immune Defic Syndr. 2016;71(3):323–30.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Ministry of Health of the People’s Republic of China. China AIDS response progress report. Beijing: UNAIDS; 2012.Google Scholar
  26. 26.
    Zou H, Hu N, Xin Q, Beck J. HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav. 2012;16(7):1717–28.CrossRefGoogle Scholar
  27. 27.
    Ibrahim S, Al Attas SA, Mansour GA, Ouda S, Fallatah H. Accuracy of rapid oral HCV diagnostic test among a Saudi sample. Clin Oral Investig. 2015;19(2):475–80.CrossRefGoogle Scholar
  28. 28.
    Wei C, Yan H, Yang C, Raymond HF, Li J, Yang H, et al. Accessing HIV testing and treatment among men who have sex with men in China: a qualitative study. AIDS Care. 2014;26(3):372–8.CrossRefGoogle Scholar
  29. 29.
    Meyer IH, Dean L. Internalized homophobia, intimacy, and sexual behavior among gay and bisexual men. Thousand Oaks: Sage; 1998.CrossRefGoogle Scholar
  30. 30.
    Xu W, Zheng L, Xu Y, Zheng Y. Internalized homophobia, mental health, sexual behaviors, and outness of gay/bisexual men from Southwest China. Int J Equity Health. 2017;16(1):36.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Campbell CK, Lippman SA, Moss N, Lightfoot M, et al. Strategies to increase HIV testing among MSM: a synthesis of the literature. AIDS Behav. 2018. Scholar
  32. 32.
    Lui CW, Dean J, Mutch A, Mao L, Debattista J, Lemoire J, et al. HIV testing in men who have sex with men: a follow-up review of the qualitative literature since 2010. AIDS Behav. 2018;22(2):593–605.CrossRefGoogle Scholar
  33. 33.
    Brown BS, O’Grady KE, Farrell EV, Flechner IS, Nurco DN. Factors associated with frequent and infrequent HIV testing. Subst Use Misuse. 2001;36(12):1593–609.CrossRefGoogle Scholar
  34. 34.
    Cheng W, Cai Y, Tang W, Zhong F, Meng G, Gu J, et al. Providing HIV-related services in China for men who have sex with men. Bull World Health Organ. 2016;94(3):222–7.CrossRefPubMedCentralGoogle Scholar
  35. 35.
    Cheng WB, Xu HF, Zhong F, Cai YS, Chen XB, Meng G, et al. Application of “Internet Plus” AIDS prevention services among men who have sex with men in Guangzhou, China: results from 2010 to 2015. Zhonghua Yu Fang Yi Xue Za Zhi. 2016;50(10):853–7.Google Scholar
  36. 36.
    Vidanapathirana J, Abramson MJ, Forbes A, Fairley C. Mass media interventions for promoting HIV testing. Cochrane Database Syst Rev. 2005. Scholar
  37. 37.
    Young SD, Cumberland WG, Nianogo R, Menacho LA, Galea JT, Coates T. The HOPE social media intervention for global HIV prevention in Peru: a cluster randomised controlled trial. Lancet HIV. 2015;2(1):e27–32.CrossRefGoogle Scholar
  38. 38.
    Katz DA, Dombrowski JC, Kerani RP, Aubin MR, Kern DA, Heal DD, et al. Integrating HIV testing as an outcome of STD partner services for men who have sex with men. AIDS Patient Care STDs. 2016;30(5):208–14.CrossRefPubMedCentralGoogle Scholar
  39. 39.
    Wilkinson AL, Pedrana AE, El-Hayek C, Vella AM, Asselin J, Batrouney C, et al. The impact of a social marketing campaign on HIV and sexually transmissible infection testing among men who have sex with men in Australia. Sex Transm Dis. 2016;43(1):49–56.CrossRefGoogle Scholar
  40. 40.
    Gilbert M, Cook D, Steinberg M, Kwag M, Robert W, Doupe G, et al. Targeting screening and social marketing to increase detection of acute HIV infection in men who have sex with men in Vancouver, British Columbia. AIDS. 2013;27(16):2649–54.CrossRefPubMedCentralGoogle Scholar
  41. 41.
    Lampkin D, Crawley A, Lopez TP, Mejia CM, Yuen W, Levy V. Reaching suburban men who have sex with men for STD and HIV services through online social networking outreach: a public health approach. J Acquir Immune Defic Syndr. 2016;72(1):73–8.CrossRefGoogle Scholar
  42. 42.
    Tucker JD, Muessig KE, Cui R, Bien CH, Lo EJ, Lee R, et al. Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models. BMC Infect Dis. 2014;14:601.CrossRefPubMedCentralGoogle Scholar
  43. 43.
    Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, et al. Acceptability and feasibility of a social entrepreneurship testing model to promote HIV self-testing and linkage to care among men who have sex with men. HIV Med. 2017;18(5):376–82.CrossRefGoogle Scholar
  44. 44.
    Martinez O, Carballo-Dieguez A, Ibitoye M, Frasca T, Brown W, Balan I. Anticipated and actual reactions to receiving HIV positive results through self-testing among gay and bisexual men. AIDS Behav. 2014;18(12):2485–95.CrossRefPubMedCentralGoogle Scholar
  45. 45.
    Gray RT, Prestage GP, Down I, Ghaus MH, Hoare A, Bradley J, et al. Increased HIV testing will modestly reduce HIV incidence among gay men in NSW and would be acceptable if HIV testing becomes convenient. PLoS ONE. 2013;8(2):e55449.CrossRefPubMedCentralGoogle Scholar
  46. 46.
    Dowson L, Kober C, Perry N, Fisher M, Richardson D. Why some MSM present late for HIV testing: a qualitative analysis. AIDS Care. 2012;24(2):204–9.CrossRefGoogle Scholar
  47. 47.
    Beougher SC, Bircher AE, Chakravarty D, Darbes LA, Mandic CG, Neilands TB, et al. Motivations to test for HIV among partners in concordant HIV-negative and HIV-discordant gay male couples. Arch Sex Behav. 2015;44(2):499–508.CrossRefGoogle Scholar
  48. 48.
    Lorente N, Henry E, Fugon L, Yomb Y, Carrieri MP, Eboko F, et al. Proximity to HIV is associated with a high rate of HIV testing among men who have sex with men living in Douala, Cameroon. AIDS Care. 2012;24(8):1020–7.CrossRefGoogle Scholar
  49. 49.
    Wagner GJ, Hoover M, Green H, Tohme J, Mokhbat J. Social, relational and network determinants of unprotected anal sex and HIV testing among men who have sex with men in Beirut, Lebanon. Int J Sex Health. 2015;27(3):264–75.CrossRefGoogle Scholar
  50. 50.
    Logie CH, Lacombe-Duncan A, Brien N, Jones N, Lee-Foon N, Levermore K, et al. Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. J Int AIDS Soc. 2017;20(1):21385.CrossRefPubMedCentralGoogle Scholar
  51. 51.
    Scott HM, Pollack L, Rebchook GM, Huebner DM, Peterson J, Kegeles SM. Peer social support is associated with recent HIV testing among young black men who have sex with men. AIDS Behav. 2014;18(5):913–20.CrossRefPubMedCentralGoogle Scholar
  52. 52.
    Pyun T, Santos GM, Arreola S, Do T, Hebert P, Beck J, et al. Internalized homophobia and reduced HIV testing among men who have sex with men in China. Asia–Pac J Public Health. 2014;26(2):118–25.Google Scholar
  53. 53.
    Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.CrossRefGoogle Scholar
  54. 54.
    Herrick AL, Lim SH, Plankey MW, Chmiel JS, Guadamuz TE, Kao U, et al. Adversity and syndemic production among men participating in the multicenter AIDS cohort study: a life-course approach. Am J Public Health. 2013;103(1):79–85.CrossRefPubMedCentralGoogle Scholar
  55. 55.
    Hatzenbuehler ML, Bellatorre A, Lee Y, Finch BK, Muennig P, Fiscella K. Structural stigma and all-cause mortality in sexual minority populations. Soc Sci Med. 2014;103:33–41.CrossRefGoogle Scholar
  56. 56.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.CrossRefPubMedCentralGoogle Scholar
  57. 57.
    Wei C, Cheung DH, Yan H, Li J, Shi LE, Raymond HF. The impact of homophobia and HIV stigma on HIV testing uptake among Chinese men who have sex with men: a mediation analysis. J Acquir Immune Defic Syndr. 2016;71(1):87–93.PubMedCentralGoogle Scholar
  58. 58.
    Bai X, Xu J, Yang J, Yang B, Yu M, Gao Y, et al. HIV prevalence and high-risk sexual behaviours among MSM repeat and first-time testers in China: implications for HIV prevention. J Int AIDS Soc. 2014;17:18848.CrossRefPubMedCentralGoogle Scholar
  59. 59.
    Boydell N, Buston K, McDaid LM. Patterns of HIV testing practices among young gay and bisexual men living in Scotland: a qualitative study. BMC Public Health. 2017;17(1):660.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Dermatology Hospital of Southern Medical UniversityGuangzhouChina
  2. 2.Guangzhou Center for Disease Control and PreventionGuangzhouChina
  3. 3.Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  4. 4.Lingnan Partners Community Support CenterGuangzhouChina
  5. 5.GuangzhouChina

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