Longhua District Center for Disease Control and Prevention, Shenzhen, China.
Department of Health and Physical Education, Education University of Hong Kong, Hong Kong, Hong Kong.
JMIR Public Health Surveill. 2022 May 25;8(5):e30070. doi: 10.2196/30070.
BACKGROUND: The COVID-19 pandemic has created disruptions in HIV prevention and sexual health services for men who have sex with men (MSM). OBJECTIVE: This study compared HIV testing utilization in 3 different reference periods (period 1: before the COVID-19 outbreak, November 2019-January 2020; period 2: after the outbreak, February-April 2020; and period 3: after the pandemic was under initial control, May-July 2020). Factors associated with HIV testing utilization after the COVID-19 outbreak (combined periods 2 and 3) were also investigated. METHODS: Participants were MSM aged ≥18 years living in Shenzhen, China. Those self-reporting as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August-September 2020. HIV testing utilization after the COVID-19 outbreak was the dependent variable, and multivariate logistic regression models were fitted. RESULTS: HIV testing utilization was significantly lower in period 2 than in period 1 (n=262 vs 363, 44.0% vs 61.0%, P<.001). However, HIV testing utilization was not significantly higher in period 3 than in period 2 (n=277 vs 262, 46.6% vs 44.0%, P=.21). The prevalence of HIV testing utilization after the COVID-19 outbreak was seen in 331 (55.6%) participants. After adjusting for significant background characteristics, condomless anal intercourse (CAI) with regular male sex partners (RPs; adjusted odds ratio [AOR] 2.15, 95% CI 1.29-3.57) and sexualized drug use (SDU; AOR 2.94, 95% CI 1.41-6.06) both before and after the COVID-19 outbreak, CAI with RPs (AOR 2.07, 95% CI 1.06-4.07) and nonregular male sex partners (NRPs; AOR 3.57, 95%CI: 1.43-8.89) only after the COVID-19 outbreak was positively associated with the dependent variable. Regarding HIV prevention service utilization, HIV testing utilization before the COVID-19 outbreak (AOR 10.75, 95% CI 7.22-16.02) and the use of sexually transmitted infection (STI) testing (AOR 7.02, 95% CI 4.10-12.02), other HIV/STI prevention (AOR 3.15, 95% CI 2.16-4.60), and preexposure prophylaxis (PrEP; AOR 3.58, 95% CI 1.54-8.34) after the COVID-19 outbreak were associated with higher HIV testing utilization. The current perceived risk of HIV infection was higher than that before the COVID-19 outbreak (AOR 1.15, 95% CI 1.01-1.30), and perceived COVID-19 preventive measures taken by HIV testing service providers to be effective (AOR 1.52, 95% CI 1.29-1.78) and perceived higher behavioral control to undergo HIV testing (AOR 1.18, 95% CI 1.00-1.40) were positively associated with HIV testing utilization. Concerns about COVID-19 infection during HIV testing (AOR 0.78, 95% CI 0.68-0.89), avoiding crowded places (AOR 0.68, 95% CI 0.48-0.98), and HIV testing service providers reducing their working hours (AOR 0.59, 95% CI 0.48-0.98) were negatively associated with the dependent variable. CONCLUSIONS: HIV testing utilization among Chinese MSM declined after the COVID-19 outbreak and did not increase after the pandemic was under initial control. Removing structural barriers to accessing HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing (HIVST) might be useful strategies to improve HIV testing among MSM during the pandemic.
背景：COVID-19 大流行扰乱了男男性行为者（MSM）的艾滋病预防和性健康服务。
目的：本研究比较了在 3 个不同参考期（期 1：COVID-19 爆发前，2019 年 11 月至 2020 年 1 月；期 2：爆发后，2020 年 2 月至 4 月；期 3：大流行初步得到控制后，2020 年 5 月至 7 月）的 HIV 检测利用情况。还调查了 COVID-19 爆发后（合并期 2 和 3）与 HIV 检测利用相关的因素。
方法：参与者为居住在中国深圳的年龄≥18 岁的 MSM。自我报告 HIV 阳性者被排除在外。2020 年 8 月至 9 月期间，通过多种来源共招募了 595 名参与者完成了在线自我调查。HIV 检测利用情况为因变量，拟合了多变量逻辑回归模型。
结果：期 2 的 HIV 检测利用明显低于期 1（n=262 vs 363，44.0% vs 61.0%，P<.001）。然而，期 3 的 HIV 检测利用并未明显高于期 2（n=277 vs 262，46.6% vs 44.0%，P=.21）。COVID-19 爆发后，有 331 名（55.6%）参与者进行了 HIV 检测。在调整了显著的背景特征后，与性伴侣（RPs）发生无保护肛交（CAI）（调整后的优势比 [AOR] 2.15，95%CI 1.29-3.57）和性使用毒品（SDU）（AOR 2.94，95%CI 1.41-6.06），与 RPs 发生 CAI（AOR 2.07，95%CI 1.06-4.07）和非固定性伴侣（NRPs）（AOR 3.57，95%CI：1.43-8.89）在 COVID-19 爆发前后均与因变量呈正相关。关于 HIV 预防服务的利用，COVID-19 爆发前的 HIV 检测利用（AOR 10.75，95%CI 7.22-16.02）和性传播感染（STI）检测（AOR 7.02，95%CI 4.10-12.02），其他 HIV/STI 预防（AOR 3.15，95%CI 2.16-4.60），以及暴露前预防（PrEP；AOR 3.58，95%CI 1.54-8.34）与 HIV 检测利用增加相关。目前感染 HIV 的风险感知高于 COVID-19 爆发前（AOR 1.15，95%CI 1.01-1.30），并认为 HIV 检测服务提供者采取的 COVID-19 预防措施有效（AOR 1.52，95%CI 1.29-1.78）和更高的行为控制能力进行 HIV 检测（AOR 1.18，95%CI 1.00-1.40）与 HIV 检测利用呈正相关。在 HIV 检测期间对 COVID-19 感染的担忧（AOR 0.78，95%CI 0.68-0.89），避免拥挤场所（AOR 0.68，95%CI 0.48-0.98），以及 HIV 检测服务提供者减少工作时间（AOR 0.59，95%CI 0.48-0.98）与因变量呈负相关。
结论：COVID-19 爆发后，中国 MSM 的 HIV 检测利用下降，大流行初步得到控制后并未增加。消除 COVID-19 对 HIV 检测获取造成的结构性障碍，改变与 HIV 检测相关的认知，并利用 HIV 自我检测（HIVST）可能是大流行期间提高 MSM 进行 HIV 检测的有用策略。
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