title: Barriers and Facilitators of Linkage to and Engagement in HIV Care Among HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study.
abstract: Linking and engaging HIV-positive patients in care is the key bridging step to glean the documented health and prevention advantages of antiretroviral therapy (ART). In China, HIV transmission among men who have sex with men (MSM) is surging, yet many HIV-positive MSM do not use HIV care services. We conducted a qualitative study in order to help positive interventions to promote linkage-to-care in this key population. Four focus group discussions (FGD) were held among HIV-positive MSM in Beijing, China, to ascertain knowledge, beliefs, attitudes, and practices related to HIV care. FGD participates highlighted six major barriers of linkage to/engagement in HIV care: (1) perceived discrimination from health care workers; (2) lack of guidance and follow-up; (3) clinic time or location inconvenience; (4) privacy disclosure concerns; (5) psychological burden of committing to HIV care; and (6) concerns about treatment. Five major sub-themes emerged from discussions on the facilitators of linkage to/engagement in care: (1) peer referral and accompaniment; (2) free HIV care; (3) advocacy from HIV-positive MSM counselors; (4) extended involvement for linking MSM to care; and (5) standardization of HIV care (i.e., reliable high quality care regardless of venue). An understanding of the barriers and facilitators that may impact the access to HIV care is essential for improving the continuum of care for MSM in China. Findings from our study provide research and policy guidance for how current HIV prevention and care interventions can be enhanced to link and engage HIV-positive MSM in HIV care.
authors.affiliation: 1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: 2 Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.|3 Department of Biomedical Informatics, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
authors.affiliation: 1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.|4 Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
authors.affiliation: 1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
authors.affiliation: 5 Chaoyang Chinese Aids Volunteer Group , Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xiao
authors.affiliation: 6 State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention , Beijing, China .
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: 7 Department of Psychology, University of Washington , Seattle, Washington.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.affiliation: 8 Xicheng District Center for Disease Control and Prevention , Beijing, China .
authors.forename: Xiangjun
authors.initials: X
authors.lastname: Zhang
authors.affiliation: 5 Chaoyang Chinese Aids Volunteer Group , Beijing, China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.affiliation: 1 Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine , Nashville, Tennessee.|2 Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.|9 Department of Pediatrics, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: 10 Department of Health Behavior and Health Education, University of Michigan , Ann Arbor, Michigan.
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003219:Confidentiality; D005239:Fear; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010379:Peer Group; D011287:Prejudice; D015995:Prevalence; D036301:Qualitative Research; D012309:Risk-Taking; D012747:Sexual Partners; D057545:Social Stigma; D012959:Socioeconomic Factors