Acceptability of Oral Fluid-Based Rapid HIV Self-Testing Among Men Who Have Sex with Men in Hefei, China

Introduction: In China, the proportion of HIV cases attributed to men who have sex with men (MSM) behavior has rapidly increased in recent years, with over one-quarter of new diagnoses occurring in this group. Additionally, HIV testing rates are low among MSM in China, with stigma and confidentiality concerns often cited as barriers to testing. Combined, these two factors have the potential to lead to thousands of new infections if cases remain undetected. Oral fluid-based rapid HIV self-testing (HST) has the potential to increase access to testing, particularly among those who face various barriers to access in-person testing. HST has been recommended in several countries, but China has yet to release guidelines about HST. The purpose of this study was to explore the acceptability of HST among MSM in China.

Methods: Qualitative interviews were conducted with MSM aged 18 and older recruited using convenience sampling in Hefei, China (n=36). Participants watched a demonstration of how to self-administer the rapid oral testing kit, then privately administered the kit themselves and were subsequently interviewed about their testing experience. All interviews were audio-recorded and transcribed in Chinese and translated into English. Thematic analysis was conducted using NVivo software.

Results: Participants reported the test was quick, convenient, and easy to use, with few errors during test administration. Advantages of HST included that it provides increased privacy and is more hygienic than the self-prick test. However, men expressed concerns about test kit authenticity and accuracy of results in comparison to blood-based HIV tests. Several men noted they would doubt the result if their test were reactive. The majority of participants reported they would be able to complete the test at home and intend to take HIV tests more regularly with HST. Regarding potential avenues of sale, many reported potential discrimination concerns purchasing the kit from a pharmacy or concerns about the potential for counterfeit kits if purchased online.

Conclusions: Oral HST appears to be an acceptable alternative form of HIV testing among MSM in Heifei, China, but additional research is needed to investigate potential avenues of sale/dissemination. Furthermore, it is necessary to assure men of the test’s accuracy.