title: A mixed-methods study on the acceptability of using eHealth for HIV prevention and sexual health care among men who have sex with men in China.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care.
  
  
  OBJECTIVE
  This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care.
  
  
  METHODS
  We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care.
  
  
  RESULTS
  The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns.
  
  
  CONCLUSIONS
  MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. kmuessig@med.unc.edu.
authors.forename: Kathryn E
authors.identifier: http://orcid.org/0000-0002-8522-3240
authors.initials: KE
authors.lastname: Muessig
authors.forename: Cedric H
authors.identifier: http://orcid.org/0000-0003-0182-5680
authors.initials: CH
authors.lastname: Bien
authors.forename: Chongyi
authors.identifier: http://orcid.org/0000-0002-4424-5523
authors.initials: C
authors.lastname: Wei
authors.forename: Elaine J
authors.identifier: http://orcid.org/0000-0003-1957-5296
authors.initials: EJ
authors.lastname: Lo
authors.forename: Min
authors.identifier: http://orcid.org/0000-0001-6745-1429
authors.initials: M
authors.lastname: Yang
authors.forename: Joseph D
authors.identifier: http://orcid.org/0000-0003-2804-1181
authors.initials: JD
authors.lastname: Tucker
authors.forename: Ligang
authors.identifier: http://orcid.org/0000-0002-6775-8970
authors.initials: L
authors.lastname: Yang
authors.forename: Gang
authors.identifier: http://orcid.org/0000-0003-1067-6007
authors.initials: G
authors.lastname: Meng
authors.forename: Lisa B
authors.identifier: http://orcid.org/0000-0002-2421-923X
authors.initials: LB
authors.lastname: Hightow-Weidman
mesh_terms: D000328:Adult; D040421:Cell Phone; D002681:China; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D060728:Reproductive Health; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D017216:Telemedicine
keywords: AIDS; China; HIV; Internet; men who have sex with men; mixed method; sexually transmitted diseases