Feasibility Study On Mobilizing Sex Partners Of HIV-positive MSM For HIV Testing

Objective:In order to evaluate the feasibility on mobilizing sex partners of HIV-positive MSM for HIV testing in Kunming so that providing advices and recommendations on methods and means of mobilizing sex partners'testing for extending and using.Methods:In May 2014 to December 2015, Rainbow Sky Center of Health Counseling and Service (Rainbow Sky for short) as the main survey field, combined with Yunnan Parallel which was another local NGO for gay men and four district CDCs in Kunming downtown. This study was conducted among HIV-positive MSM (seed) to mobilize their sex partners for HIV testing. Recruited seed by judgment sampling and mobilized sex partners to accept investigation and HIV testing by snowball sampling. One-to-one questionnaire interviews were conducted to collect information of seed and partners on socio-demographics, sexual behaviors, willingness of mobilizing sex partners for HIV testing, the choice of mobilizing methods, previous HIV testing experience, etc. The necessity acceptability and feasibility of mobilizing sex partners of HIV-positive MSM for HIV testing was evaluated by the rate of sex partners'HIV-positive findings, the rate of seed willing to participate in mobilizing and the success rate of HIV testing in the sex partners respectively. SPSS 21.0 software was used to analyze the data with descriptive statistics, chi-square tests, Fisher exact probability test and Logistic regression analysis. In addition, this study also used qualitative interview for seed, sero-negative sex partners, health workers of community organizations or CDC to complete the information from questionnaires.Results:1. The survey of the risk of HIV infection in the sex partners indicated that 137 HIV-positive MSM (seed) mobilized 105 sex partners which included 38 regular male sex partners,44 casual male sex partners and 23 female spouses had been received HIV counseling and testing successfully,16 partners were detected HIV-positive, the rate of sex partners' HIV-positive findings and male sex partners' HIV-positive findings were 15.2%(16/105) and 19.5%(16/82) respectively. In multivariate Logistic regression analysis, the male sex partners who had detected previously (OR=0.217, 95% CI=0.063-0.745) demonstrated to be the protective factor of partners' infection. The male sex partners who were consistent condom use of anal intercourse in last 6 months had lower risk of infected than whom never used condoms (OR=0.024,95% CI=0.002-0.397), and the male sex partners who had anal intercourse with seed used condoms casually had higher risk of infected than whom insisted using condoms (OR= 3.431,95%CI= 1.012-11.631). Through the deep-interview we found that the casual sexual behavior which was after getting drunk and having some substances abused (like RUSH, ice, etc.) might increase the risk of infected.2. The survey on the willingness of seed to mobilize their sex partners with HIV testing indicated that there were 62.7%(147/233) of the seeds expressed willingness to participate in mobilizing their sex partners to received HIV testing. Factors positively associated with willingness were:the seeds who were previously-diagnosed with HIV (OR=2.427 95%CI= 1.341-4.390) and the type of sex partners was regular male sex-partner (OR=3.101,95%CI=1.537-6.255). In addition, through the deep-interview we found that the degree on difficulty of mobilizing from easy to difficult was that, regular male sex partners> female spouses> casual male sex partners>others(i.e. commercial sex partners etc.). As for the reasons why seed unwilling to mobilize their sex partners to received HIV testing, the top three were, losing contact (47.6%) mostly, worrying about exposure to their infection status (17.5%), unknowing how to communicate (9.5%). And through the deep-interview we also found other reasons such as though it was unnecessary and worrying about being hurt (like a threat, fame damage, economic loss, violence, etc).3. The survey on the success rate and factors of HIV testing in the sex partners indicated that there were 146 seeds willing to mobilize their sex partners to received HIV testing and 105 sex partners received HIV testings and investigations eventually, the success ratio was 71.9%. Factors positively associated with success ratio of HIV testing for sex partners were:the type of sex partners was female-spouse (OR=14.095, 95%CI=1.717?115.712) compared to casual male sex-partner; the success rate of partner testing increased with the increase of seed age (OR=2.344, 95%CI=1.441-3.813). Through the deep-interview we found that the prejudice, discrimination and shame for HIV testing and AIDS might also affect the success ratio.Conclusions:It is high that the rate of sex partners'HIV-positive findings, the rate of seed willing to participate in mobilizing and the success rate of HIV testing in the sex partners. And this study indicates that, it is necessary acceptable and feasible that mobilizing sex partners of HIV-positive MSM for HIV testing and having a high rate of sex partners'HIV-positive findings. It is helpful in expanding HIV testing coverage, could do the targeted intervention for the high-risk contacts, increase more and earlier infected findings and plays a vital role in controlling the spread of HIV between MSM sexual partners and preventing the second generation transmission.Suggestions:1. Improve the working process:counselors should understand the infection of individual characteristics, for intervention to help seed selection suitable with mobilization means and methods. There are no biases, no discriminations in the working process, counselors should strictly abide by the principle of confidentiality and regular follow-up of seeds and sexual partners, to encourage the formation of periodic testing and partners'testing awareness.2. Promote the using:this method is suitable for the MSM community organizations which are rich of experienced, organized and standardized combined this part of work in their routine management and follow-up work. On the basis of this study, summarized and further improve the working process, strengthening counselors training, gradually expanding the method to be used in other more regions.