title: Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey.
abstract: HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China.
  
  
  
  MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing.
  
  
  
  1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04).
  
  
  
  HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.
authors.affiliation: SESH Research Team at the School of Medicine, University of North Carolina at Chapel Hill, Guangzhou, China.|Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
authors.forename: Tiange P
authors.initials: TP
authors.lastname: Zhang
authors.affiliation: SESH Research Team at the School of Medicine, University of North Carolina at Chapel Hill, Guangzhou, China.|University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
authors.forename: Chuncheng
authors.initials: C
authors.lastname: Liu
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
authors.forename: Larry
authors.initials: L
authors.lastname: Han
authors.affiliation: SESH Research Team at the School of Medicine, University of North Carolina at Chapel Hill, Guangzhou, China.|University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Guangdong Provincial Center for Skin Diseases and Sexually Transmitted Infections Control, Guangzhou, China.
authors.forename: Weiming
authors.initials: W
authors.lastname: Tang
authors.affiliation: SESH Research Team at the School of Medicine, University of North Carolina at Chapel Hill, Guangzhou, China.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mao
authors.affiliation: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Terrence
authors.initials: T
authors.lastname: Wong
authors.affiliation: SESH Research Team at the School of Medicine, University of North Carolina at Chapel Hill, Guangzhou, China.|University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|Guangdong Provincial Center for Skin Diseases and Sexually Transmitted Infections Control, Guangzhou, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: SESH Research Team at the School of Medicine, University of North Carolina at Chapel Hill, Guangzhou, China.|University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
authors.forename: Songyuan
authors.initials: S
authors.lastname: Tang
authors.affiliation: Guangdong Provincial Center for Skin Diseases and Sexually Transmitted Infections Control, Guangzhou, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
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: SESH Research Team at the School of Medicine, University of North Carolina at Chapel Hill, Guangzhou, China.|University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
mesh_terms: D000328:Adult; D002681:China; D003256:Community Participation; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000175:diagnosis*; D006306:Health Surveys; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D060728:Reproductive Health; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis*; D055815:Young Adult
keywords: China; HIV; HIV testing; community engagement; low- and middle-income countries (LMICs); men who have sex with men (MSM); syphilis testing