title: Barriers and facilitators of linkage to HIV care among HIV-infected young Chinese men who have sex with men: a qualitative study.
abstract: The Four Free and One Care Policy (HIV/AIDS-related free services) has been in place in China since 2004. However, linkage to human immunodeficiency virus (HIV) care is not yet achieved very well among people living with HIV. We conducted a qualitative study to explore individual and contextual factors that may influence a linkage to HIV care from the perspective of young HIV-infected men who have sex with men (MSM) in a highly centralized HIV care context of China.
  
  
  
  Purposive sampling was used to recruit 21 HIV-infected MSM in Shandong Province, with in-depth interviews conducted between March and July 2015. Thematic content analysis was subsequently used for data analysis.
  
  
  
  Key barriers and facilitators related to a linkage to HIV care emerged from participants' narratives. The barriers included perceived healthy status, low health literacy, and stigma associated with receiving HIV care. The facilitators included an awareness of responsibility, knowledge associated with health literacy, social support, and trusting and relying on services provided by the Center for Disease Control and Prevention (CDC) and the government. These were related to the quality of current HIV counselling and testing, service promotion, and the cost and placement of these HIV services.
  
  
  
  In order to improve the MSM linkage to HIV care in China, it is imperative to improve the quality of the current on-going counselling and testing. Further critical linkage support includes increasing supportive services among local CDC systems, designated hospitals and community-based organizations (CBOs), and more financial support for HIV/AIDS related testing, medical checkups and treatments.
authors.affiliation: School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China.|UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Haochu
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, CA, USA.
authors.forename: Chongyi
authors.initials: C
authors.lastname: Wei
authors.affiliation: UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tucker
authors.affiliation: Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
authors.forename: Dianmin
authors.initials: D
authors.lastname: Kang
authors.affiliation: Shandong Provincial Center for Disease Control and Prevention, Jinan, China.
authors.forename: Meizhen
authors.initials: M
authors.lastname: Liao
authors.affiliation: School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Holroyd
authors.affiliation: School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China.
authors.forename: Jietao
authors.initials: J
authors.lastname: Zheng
authors.affiliation: School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Qi
authors.affiliation: School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China. weima@sdu.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D044466:Asian People; D001364:Awareness; D002681:China / Q000208:ethnology; D003141:Communicable Diseases; D003376:Counseling / Q000706:statistics & numerical data; D005378:Financial Support; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012941:Social Responsibility; D057545:Social Stigma; D012944:Social Support; D055815:Young Adult
keywords: China; HIV; Linkage to care; Men who have sex with men; Qualitative