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Published in: BMC Infectious Diseases 1/2022

Open Access 01-12-2022 | Syphilis | Research

Coerced syphilis self-testing among men who have sex with men: a nationwide cross-sectional study in China

Authors: Peizhen Zhao, Yijia Shi, Cheng Wang

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Syphilis testing uptake remains low among men who have sex with men (MSM) in many low-and middle-income countries. Syphilis self-testing is an efficacious approach on increasing syphilis testing coverage. However, one unintended consequence is the syphilis self-testing coercion from others (including partners, healthcare providers, friends, etc.). This study aimed to examine the prevalence, pattern and correlates of coerced syphilis self-testing among MSM in China.

Methods

A nationwide online cross-sectional study was conducted from 14 to 28 July 2018. Sociodemographic characteristics, sexual behaviors and coerced syphilis self-testing variables were collected through a questionnaire that targeted MSM in China. Multivariable logistic regression was used to explore associated factors with syphilis self-testing coercion.

Results

Overall, 174 MSM were recruited in this study, 31 men (17.8%) reported ever experiencing syphilis self-testing coercion. The most common types of coercion before syphilis self-testing were verbal abuse (38.7%, 12/31) and threatening to end a relationship (38.7%, 12/31). After obtaining the self-test results, men were mostly subjected to end a relationship (45.2%, 14/31) and threaten of violence (35.5%, 11/31). Multivariable logistic regression indicated that men who used condoms inconsistently in the past three months, ever used substances before or during sex, ever had group sex with males and commercial sex were more likely to experience syphilis self-testing coercion.

Conclusions

Coerced syphilis self-testing was prevalent among MSM in China. Innovative intervention to reduce coerced syphilis self-testing is necessary among MSM in China.
Appendix
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Literature
1.
go back to reference Zhao P, Yang Z, Li B, Xiong M, Zhang Y, Zhou J, Wang C. Simple-to-use nomogram for predicting the risk of syphilis among MSM in Guangdong Province: results from a serial cross-sectional study. BMC Infect Dis. 2021;21(1):1199.CrossRef Zhao P, Yang Z, Li B, Xiong M, Zhang Y, Zhou J, Wang C. Simple-to-use nomogram for predicting the risk of syphilis among MSM in Guangdong Province: results from a serial cross-sectional study. BMC Infect Dis. 2021;21(1):1199.CrossRef
2.
go back to reference Tucker JD, Hawkes SJ, Yin Y, Peeling RW, Cohen MS, Chen X. Scaling up syphilis testing in China: implementation beyond the clinic. B World Health Organ. 2010;88(6):452–7.CrossRef Tucker JD, Hawkes SJ, Yin Y, Peeling RW, Cohen MS, Chen X. Scaling up syphilis testing in China: implementation beyond the clinic. B World Health Organ. 2010;88(6):452–7.CrossRef
3.
go back to reference National Health Commission of the People’s Republic of China, The Guideline for Diagnosis of syphilis, 2018. National Health Commission of the People’s Republic of China, The Guideline for Diagnosis of syphilis, 2018.
4.
go back to reference Zhang TP, Liu C, Han L, Tang W, Mao J, Wong T, Zhang Y, Tang S, Yang B, Wei C, et al. Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int Aids Soc. 2017;20(1):21372.CrossRef Zhang TP, Liu C, Han L, Tang W, Mao J, Wong T, Zhang Y, Tang S, Yang B, Wei C, et al. Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int Aids Soc. 2017;20(1):21372.CrossRef
5.
go back to reference Zhao P, Cheng W, Tang W, Zheng H, Yang B, Wang C. Evaluating the effectiveness of HIV/syphilis joint self-testing in promoting syphilis testing among men who have sex with men. Chin J Epidemiol. 2021;42(02):273–7. Zhao P, Cheng W, Tang W, Zheng H, Yang B, Wang C. Evaluating the effectiveness of HIV/syphilis joint self-testing in promoting syphilis testing among men who have sex with men. Chin J Epidemiol. 2021;42(02):273–7.
6.
go back to reference Sri-Pathmanathan C, Nhamo D, Mamvuto T, Chapwanya G, Terris-Prestholt F, Mahaka I, Marks M, Tucker JD. Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe. Sex Transm Infect 2022;98(3):197–202. Sri-Pathmanathan C, Nhamo D, Mamvuto T, Chapwanya G, Terris-Prestholt F, Mahaka I, Marks M, Tucker JD. Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe. Sex Transm Infect 2022;98(3):197–202.
7.
go back to reference Wang C, Ong JJ, Zhao P, Weideman AM, Tang W, Smith MK, Marks M, Fu H, Cheng W, Terris-Prestholt F, et al. Expanding syphilis test uptake using rapid dual self-testing for syphilis and HIV among men who have sex with men in China: a multiarm randomized controlled trial. PLoS Med. 2022;19(3): e1003930.CrossRef Wang C, Ong JJ, Zhao P, Weideman AM, Tang W, Smith MK, Marks M, Fu H, Cheng W, Terris-Prestholt F, et al. Expanding syphilis test uptake using rapid dual self-testing for syphilis and HIV among men who have sex with men in China: a multiarm randomized controlled trial. PLoS Med. 2022;19(3): e1003930.CrossRef
8.
go back to reference Wang C, Cheng W, Li C, Tang W, Ong JJ, Smith MK, Fu H, Marks M, Nie J, Zheng H, et al. Syphilis self-testing: a nationwide pragmatic study among men who have sex with men in China. Clin Infect Dis. 2020;70(10):2178–86.CrossRef Wang C, Cheng W, Li C, Tang W, Ong JJ, Smith MK, Fu H, Marks M, Nie J, Zheng H, et al. Syphilis self-testing: a nationwide pragmatic study among men who have sex with men in China. Clin Infect Dis. 2020;70(10):2178–86.CrossRef
9.
go back to reference Sidman M. Reflections on behavior analysis and coercion. Behav Soc Issues. 1993;3(1):75–85.CrossRef Sidman M. Reflections on behavior analysis and coercion. Behav Soc Issues. 1993;3(1):75–85.CrossRef
10.
go back to reference Carroll JS. Consent to mental health treatment: a theoretical analysis of coercion, freedom, and control. Behav Sci Law. 1991;9(2):129–42.CrossRef Carroll JS. Consent to mental health treatment: a theoretical analysis of coercion, freedom, and control. Behav Sci Law. 1991;9(2):129–42.CrossRef
11.
go back to reference Ong JJ, Li H, Dan W, Fu H, Liu E, Ma W, Kang D, Liao M, Marley G, Wei C, et al. Coercion and HIV self-testing in men who have sex with men: implementation data from a cross-sectional survey in China. JAIDS J Acquir Immune Defic Syndr. 2018;77(2):e22–5.CrossRef Ong JJ, Li H, Dan W, Fu H, Liu E, Ma W, Kang D, Liao M, Marley G, Wei C, et al. Coercion and HIV self-testing in men who have sex with men: implementation data from a cross-sectional survey in China. JAIDS J Acquir Immune Defic Syndr. 2018;77(2):e22–5.CrossRef
12.
go back to reference Ong JJ, Wu D, Huang W, Fu H, Desmond N, Ma W, Kang D, Liao M, Marley G, Wei C, et al. Pressured HIV testing “in the name of love”: a mixed methods analysis of pressured HIV testing among men who have sex with men in China. J Int AIDS Soc. 2018;21(3): e25098.CrossRef Ong JJ, Wu D, Huang W, Fu H, Desmond N, Ma W, Kang D, Liao M, Marley G, Wei C, et al. Pressured HIV testing “in the name of love”: a mixed methods analysis of pressured HIV testing among men who have sex with men in China. J Int AIDS Soc. 2018;21(3): e25098.CrossRef
13.
go back to reference Qin Y, Tang W, Nowacki A, Mollan K, Reifeis SA, Hudgens MG, Wong N, Li H, Tucker JD, Wei C. Benefits and potential harms of human immunodeficiency virus self-testing among men who have sex with men in China: an implementation perspective. Sex Transm Dis. 2017;44(4):233–8.CrossRef Qin Y, Tang W, Nowacki A, Mollan K, Reifeis SA, Hudgens MG, Wong N, Li H, Tucker JD, Wei C. Benefits and potential harms of human immunodeficiency virus self-testing among men who have sex with men in China: an implementation perspective. Sex Transm Dis. 2017;44(4):233–8.CrossRef
14.
go back to reference Choko AT, MacPherson P, Webb EL, Willey BA, Feasy H, Sambakunsi R, Mdolo A, Makombe SD, Desmond N, Hayes R, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in Blantyre, Malawi: a community-based prospective study. PLoS Med. 2015;12(9): e1001873.CrossRef Choko AT, MacPherson P, Webb EL, Willey BA, Feasy H, Sambakunsi R, Mdolo A, Makombe SD, Desmond N, Hayes R, et al. Uptake, accuracy, safety, and linkage into care over two years of promoting annual self-testing for HIV in Blantyre, Malawi: a community-based prospective study. PLoS Med. 2015;12(9): e1001873.CrossRef
15.
go back to reference Gwynn M, Chavez PR, Borkowf CB, Raiford JL, Gravens L, MacGowan RJ. Pressure to use HIV self-tests among men who have sex with men, United States, 2015–2016. AIDS Behav. 2022;26(2):623–30. Gwynn M, Chavez PR, Borkowf CB, Raiford JL, Gravens L, MacGowan RJ. Pressure to use HIV self-tests among men who have sex with men, United States, 2015–2016. AIDS Behav. 2022;26(2):623–30.
16.
go back to reference World Health Organization. Guidelines on HIV selftesting and partner notification: supplement to consolidated guidelines on HIV testing services. 2016. World Health Organization. Guidelines on HIV selftesting and partner notification: supplement to consolidated guidelines on HIV testing services. 2016.
17.
go back to reference Choko AT, Nanfuka M, Birungi J, Taasi G, Kisembo P, Helleringer S. A pilot trial of the peer-based distribution of HIV self-test kits among fishermen in Bulisa, Uganda. PLoS ONE. 2018;13(11): e208191. Choko AT, Nanfuka M, Birungi J, Taasi G, Kisembo P, Helleringer S. A pilot trial of the peer-based distribution of HIV self-test kits among fishermen in Bulisa, Uganda. PLoS ONE. 2018;13(11): e208191.
18.
go back to reference Chen G, Cao Y, Yao Y, Li M, Tang W, Li J, Babu GR, Jia Y, Huan X, Xu G, et al. Syphilis incidence among men who have sex with men in China: results from a meta-analysis. Int J STD AIDS. 2017;28(2):170–8.CrossRef Chen G, Cao Y, Yao Y, Li M, Tang W, Li J, Babu GR, Jia Y, Huan X, Xu G, et al. Syphilis incidence among men who have sex with men in China: results from a meta-analysis. Int J STD AIDS. 2017;28(2):170–8.CrossRef
19.
go back to reference Rwafa T, Shamu S, Christofides N. Relationship power and HIV sero-status: an analysis of their relationship among lowincome urban Zimbabwean postpartum women. BMC Public Health. 2019;19(1):792. Rwafa T, Shamu S, Christofides N. Relationship power and HIV sero-status: an analysis of their relationship among lowincome urban Zimbabwean postpartum women. BMC Public Health. 2019;19(1):792.
20.
go back to reference Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, Tang S, Fan L, Zhao Y, Chen X, 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.CrossRef Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, Tang S, Fan L, Zhao Y, Chen X, 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.CrossRef
21.
go back to reference Rapid Response Service. The risk of coercion in the context of HIV self-testing. Toronto, ON: Ontario HIV Treatment Network; September 2019. Rapid Response Service. The risk of coercion in the context of HIV self-testing. Toronto, ON: Ontario HIV Treatment Network; September 2019.
22.
go back to reference Zhao P, Liu L, Zhang Y, Cheng H, Cao B, Liu C, Wang C, Yang B, Wei C, Tucker JD et al. The interaction between HIV testing social norms and self-efficacy on HIV testing among Chinese men who have sex with men: results from an online cross-sectional study. BMC INFECT DIS. 2018, 18(1). Zhao P, Liu L, Zhang Y, Cheng H, Cao B, Liu C, Wang C, Yang B, Wei C, Tucker JD et al. The interaction between HIV testing social norms and self-efficacy on HIV testing among Chinese men who have sex with men: results from an online cross-sectional study. BMC INFECT DIS. 2018, 18(1).
23.
go back to reference Wei D, Hou F, Hao C, Gu J, Dev R, Cao W, Peng L, Gilmour S, Wang K, Li J. Prevalence of intimate partner violence and associated factors among men who have sex with men in China. J Interpers Violence 2021;36:21–22. Wei D, Hou F, Hao C, Gu J, Dev R, Cao W, Peng L, Gilmour S, Wang K, Li J. Prevalence of intimate partner violence and associated factors among men who have sex with men in China. J Interpers Violence 2021;36:21–22.
24.
go back to reference Wong V, Johnson C, Cowan E, Rosenthal M, Peeling R, Miralles M, Sands A, Brown C. HIV self-testing in resource-limited settings: regulatory and policy considerations. AIDS Behav. 2014;18(S4):415–21.CrossRef Wong V, Johnson C, Cowan E, Rosenthal M, Peeling R, Miralles M, Sands A, Brown C. HIV self-testing in resource-limited settings: regulatory and policy considerations. AIDS Behav. 2014;18(S4):415–21.CrossRef
25.
go back to reference Gagnon M, French M, Hébert Y. The HIV self-testing debate: where do we stand? BMC Int Health Hum R. 2018;18(1):5. Gagnon M, French M, Hébert Y. The HIV self-testing debate: where do we stand? BMC Int Health Hum R. 2018;18(1):5.
26.
go back to reference Scott PA. Unsupervised self-testing as part public health screening for HIV in resource-poor environments: some ethical considerations. AIDS Behav. 2014;18(S4):438–44.CrossRef Scott PA. Unsupervised self-testing as part public health screening for HIV in resource-poor environments: some ethical considerations. AIDS Behav. 2014;18(S4):438–44.CrossRef
27.
go back to reference Peinado S, Treiman K, Uhrig JD, Taylor JC, Stryker JE. Effectively communicating about HIV and other health disparities: findings from a literature review and future directions. Front Commun (Lausanne). 2020;5:10. Peinado S, Treiman K, Uhrig JD, Taylor JC, Stryker JE. Effectively communicating about HIV and other health disparities: findings from a literature review and future directions. Front Commun (Lausanne). 2020;5:10.
28.
go back to reference Witzel TC, Lora W, Lees S, Desmond N, Fox MP. Uptake contexts and perceived impacts of HIV testing and counselling among adults in East and Southern Africa: a meta-ethnographic review. PLoS ONE. 2017;12(2): e170588.CrossRef Witzel TC, Lora W, Lees S, Desmond N, Fox MP. Uptake contexts and perceived impacts of HIV testing and counselling among adults in East and Southern Africa: a meta-ethnographic review. PLoS ONE. 2017;12(2): e170588.CrossRef
29.
go back to reference Qiao S, Zhou G, Li X. Disclosure of same-sex behaviors to health-care providers and uptake of HIV testing for men who have sex with men: a systematic review. Am J Mens Health. 2018;12(5):1197–214.CrossRef Qiao S, Zhou G, Li X. Disclosure of same-sex behaviors to health-care providers and uptake of HIV testing for men who have sex with men: a systematic review. Am J Mens Health. 2018;12(5):1197–214.CrossRef
30.
go back to reference Wang C, Mollan KR, Hudgens MG, Tucker JD, Zheng H, Tang W, Ling L. Generalisability of an online randomised controlled trial: an empirical analysis. J Epidemiol Community Health. 2018;72(2):173–8.CrossRef Wang C, Mollan KR, Hudgens MG, Tucker JD, Zheng H, Tang W, Ling L. Generalisability of an online randomised controlled trial: an empirical analysis. J Epidemiol Community Health. 2018;72(2):173–8.CrossRef
31.
go back to reference Memon MA, Ting H, Cheah J-H, Thurasamy R, Chuah F, Cham TH. Sample size for survey research: review and recommendations. J Appl Struct Equ Model. 2020;2(4):i–xx. Memon MA, Ting H, Cheah J-H, Thurasamy R, Chuah F, Cham TH. Sample size for survey research: review and recommendations. J Appl Struct Equ Model. 2020;2(4):i–xx.
Metadata
Title
Coerced syphilis self-testing among men who have sex with men: a nationwide cross-sectional study in China
Authors
Peizhen Zhao
Yijia Shi
Cheng Wang
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Syphilis
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07476-2

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