Abstract
BackgroundThe 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.MethodsPurposive 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.ResultsKey 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.ConclusionsIn 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.
Highlights
The Four Free and One Care Policy (HIV/Acquired immune deficiency syndrome (AIDS)-related free services) has been in place in China since 2004
Sociodemographic characteristics We recruited a total of 21 eligible participants (Table 1), including nine human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) who were linked to HIV care, ten who faced delayed entry into HIV care, and two who were not linked
Our analysis found the presence of specific barriers, such as worrying about confidentiality, negative attitudes, emotions, psychological burden, and limitations in Center for Disease Control and Prevention (CDC) services, and specific facilitators, such as peer referral and accompaniment, and free HIV care, which are in line with the study of Liu and colleagues (2016) [15]
Summary
The Four Free and One Care Policy (HIV/AIDS-related free services) has been in place in China since 2004. 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. In China, the HIV epidemic has been expanding rapidly among men who have sex with men (MSM), accounting for 17.4% of people living with HIV (PLWH) [6]. In order to reduce HIV infections among Chinese MSM, improved identification of unrecognized infections and timely linkage to care and treatment are critical. A modeling study conducted in China reported that if the testing rate had increased from 50 to 70% and treatment coverage for PLWH had increased to 55% (since 2013), a 25% reduction in annual number of new HIV infections by 2015 might have been achieved [7]. Many MSM were reported being lost to follow-up at the time of HIV confirmation and cluster of differentiation 4 (CD4) testing
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